颈部恶性纤维组织细胞瘤27例的外科治疗

Surgical treatment for 27 cases of malignant fibrous histiocytoma in the soft tissue of the neck

目的:通过外科治疗的颈部软组织恶性纤维组织细胞瘤27例分析,提出合理的选择手术方式的依据。方法:中国医学科学院肿瘤医院1972年1月～1993年12月外科治疗的颈部软组织恶性纤维组织细胞瘤共27例。其中男19例,女8例,年龄15～67岁,平均44岁。依据手术方式分为局部切除和颈部组织整块切除两组。分别统计两组的肿瘤平均直径、局部复发率和五年生存率。结果:局部切除组21例,颈部组织整块切除组6例。肿瘤平均直径:局部切除组小于5厘米,颈部组织整块切除组6厘米以上。局部复发:局部切除组16例局部复发,复发率76.2%(16/21)。颈部组织整块切除组1例复发,复发率16.7%(1/6)。两组对比,差异有显著性(x^2检验,P=0.015)。五年生存率:无复发组为89%,复发组为52%,两组对比,差异有显著性(LogRank,P=0.0264)。结论:对于颈部软组织的恶性纤维组织细胞瘤,不能仅依据肿瘤直径大小选择手术方式,而应做颈部整块组织切除,以期降低局部复发率,提高生存率。

Purpose:An analysis of 27 patients who underwent surgery for their malignant fibrous histiocytoma in the soft tissue of the neck was done to show that compartment dissection of the neck should be the optimal choices of treatment. Methods:From 1 st Jan 1972 through 31 st Dec 1993,27 patients who were referred to the Cancer Hospital for surgical treat- ment were reviewed,including 19 males and 8 females in the age range from 15 to 67,with a mean of 44 years.Surgery was classified as wide resection and compartment dissection of the neck.The two groups were compared for local recurrence and 5 years survival rates.Results:Of the 27 operations,21 were wide resections and 6 compartment dissection of the necks.The average tumor diameter was<5 millimeters in patients with wide resection and>6 millimeters in patients with compartment dissection of the neck.Local recurrence was encountered in 16 of 21 wide resections (76.2%),and in 1 of 6 compartment dissection of the necks (16.7%).The difference between the two groups was statistically significant (P= 0.015).The 5 years survival was 89% for patients without local recurrence and 52% for patients with local recurrence. The difference between them was significant statistically (Log Rank,P=0.0264).Conclusions:For malignant fibrous his- tiocytoma in the soft tissue of the neck,compartment dissection of the neck is recommended as the optimal operation for its ability to the local control of the disease locally.