背部弹力纤维瘤71例临床特点及诊治分析

Clinical characteristics and treatment of elastofibroma dorsi: experience in 71 cases

目的探讨背部弹力纤维瘤的诊断及治疗策略。方法回顾性分析2010年1月至2017年4月首都医科大学密云教学医院经病理诊断为背部弹力纤维瘤的71例患者的临床资料,总结弹力纤维瘤的临床特点,典型影像学表现及病理改变,术中、术后情况及近远期手术疗效。结果本组病例71例,其中男性14例,女性57例,发病部位均为肩胛下角,18例(25. 4%)为双侧病变。16例有局部受压时不适感,19例有局部酸胀或疼痛感,1例伴有同侧上肢麻木感,35例(49. 3%)无不适症状。肿物长径4~14cm,平均长径(8. 46±2. 67) cm。所有患者均在术前依据典型发病部位及典型影像学表现作出正确诊断。手术方式为局部麻醉/全身麻醉下肿物切除术。术后主要合并症为伤口积液,穿刺抽液后治愈。手术后以超声局部检查随访,随访时间2~85个月(中位时间23. 16个月),无复发。结论肩胛下角区域为弹力纤维瘤好发部位,单纯依据典型体检结果及特征性影像学表现,在手术前即可作出正确诊断。局部切除的近、远期效果良好。

Objective To summarize the experience in the diagnosis and treatment of elastofibroma dorsi. Methods Clinical data of 71 cases of pathologically determined elastofibroma dorsi from January 2010 to April 2017 were retrospectively reviewed,including clinical characteristics,radiological examinations and pathological alterations,surgery,postoperative complications. Results Most patients were female( 57/71) in this series. All the lesions were located within the muscles in the subscapular region. There were 18 cases with bilateral involvement. Patients complained of pain( 19/71) and feeling of foreign body( 16/71). One case was associated with numbness of the lateral upper limb,and thirty-five patients were asymptomatic. The size of the masses was between 4 centimeters to 14 centimeters,averaging at( 8. 46 ± 2. 67) centimeters. Accurate diagnosis was made in all the cases before the histological exams solely based on the physical examination and imaging findings. Marginal resection was done for all the cases under local anesthesia or general anesthesia. Seroma,as the major complication,which was resolved by repeated paracentesis. Sixty-five cases were followed-up with ultrasonic. No recurrence was found during the follow-up period( 2 months to 85 months,median 23. 16 months). Conclusion Elastofibroma dorsi is frequently located between inferior corner of scapula and posterior chest wall. It is a very special type of soft tissue tumors that its diagnosis call usually be made solely on the basis of unique imaging characteristics and physical examination before the histological exam. Surgical marginal excision is the choice of treatment with good short-term and long-term results.