血管重建在软组织肉瘤累及肢体主要血管时的应用

Application of vascular reconstruction in cases of extremity soft tissue sarcoma involving the major vessels

目的:探讨人工血管重建对肢体软组织肉瘤累及大血管的保肢手术的临床意义。方法:收集2012年至2022年间我院所做的5例人工血管重建保肢手术案例资料,并结合文献进行分析。结果:所纳入5例患者均行肉瘤整体切除联合人工血管重建。其中平滑肌肉瘤2例,未分化多形性肉瘤1例,去分化脂肪肉瘤1例,侵袭性纤维瘤病1例;累及股动脉3例,股静脉3例,锁骨下动脉1例;累及臂丛神经1例,股神经1例。随访期间出现局部复发2例,远处转移2例,其中1例因多次复发转移行3次手术治疗;出现血管闭塞1例,行血管内介入手术后开通,余4例通畅;1例患者随访4月后死亡,最长随访时间10年。结论:肉瘤的生物学行为特征是影响血管重建的关键因素,同时对周围神经的保护也需要重视。

Objective:To explore the clinical significance of synthetic vascular reconstruction in limb-sparing surgery for extremity soft tissue sarcoma involving the major vessels.Methods:The data of five cases of limb-sparing surgery with synthetic vascular reconstruction performed by our hospital from 2012 to 2022 were collected and analyzed in combination with the literature.Results:Total sarcoma resection combined with synthetic vascular reconstruction was done in all five cases in the group.There were two cases of leiomyosarcoma,one case of undifferentiated polymorphic sarcoma,one case of dedifferentiated liposarcoma,and one case of aggressive fibromatosis.Three femoral arteries,three femoral veins,and one subclavian artery were involved.One brachial plexus and one femoral nerve were involved.During the follow-up period,two patients developed local recurrence and two developed distant metastasis,one patient underwent three surgical treatments due to multiple recurrent or metastases.One case of vascular occlusion occurred,which was opened by endovascular intervention,and the remaining four cases were unobstructed.One patient died after four months of follow-up,with a maximum follow-up time of 10 years.Conclusion:The biological behavior characteristics of sarcoma are the crucial factors affecting vascular reconstruction,and the protection of peripheral nerves also needs attention.