软组织肉瘤的非计划切除

虽然软组织肿瘤的发病率较高，但其中以良性肿瘤居多1]，而软组织肉瘤的发病率较低，仅占所有恶性肿瘤的0.8%～1.0%2-3]。在我国，目前尚没有有效的转诊制度。骨与软组织肿瘤的患者，特别是软组织肿瘤的患者的治疗既有在骨科进行的，也有在普通外科进行的，甚至于在其他的一些外科专业科室接受治疗4]。即便是在骨科进行治疗，也多不是经由专业的骨与软组织肿瘤专业医师。另一方面，我国的骨与软组织肿瘤专科培训工作尚不普及，地区差别较大。甚至于发达地区的大型综合医院，其骨与软组织肿瘤的治疗理念也与专科医师存在巨大的差异。临床上，特别是那些发生在深筋膜浅层的肿物，经常会见到在没有术前影像学检查的情况下，或仅凭一个B超报告就进行了草率的切除而术后病理证实为软组织肉瘤的病例。有时甚至是直到复发再次就诊时都没有第一次手术后病理诊断的病例。因此，治疗方法参差不齐，效果难以保障。一旦患者术后诊断为肉瘤，就会给患者造成不必要的损失。

Unplanned resection of soft tissue sarcomas

The incidence of soft tissue sarcomas is relatively low, about which the doctors may not have enough knowledge except cancer specialists. In our country, the treatment varies in different regions. As a result, unplanned resection may frequently occur, and negative effects on the patients may be caused. Standard protocols should be followed in the diagnosis and treatment of soft tissue tumors, so as to avoid it as frequently as possible. For the patients receiving unplanned resection, re-excision is needed to locally control such things the tumors. But the pattern or the surgical margin of the second surgery and the adjuvant therapy may be individualized. The detailed imaging examination before the second surgery is necessary. The positive pathology report results after the re-excision may lead to increased local recurrence rate. So pathologists should work together with surgeons when taking such specimens. The controversy still remains about the effects of unplanned resection on the overall survival in patients with soft tissue sarcomas, and more evidence is needed. However, more harm and economic burden will be brought to the patients due to the re-excision. So a better referral system should be made and the surgeons＇ skills in the diagnosis and treatment should be continuously improved.