肢体恶性软组织肿瘤的保肢治疗

目的 探讨四肢恶性软组织肿瘤保肢治疗的可行性。方法 22例肢体恶性软组织肿瘤患者中,滑膜肉瘤9例,横纹肌肉瘤及恶性纤维组织细胞瘤各5例。透明细胞肉瘤2例,恶性黄色肉芽肿1例。其中股部9例,臀部4例,膝部、足跟部各3例,小腿外侧、腕部、足背部各1例。16例行肿瘤扩大切除术,6例行肿瘤扩大切除皮瓣修复术。术后采用CVADIC方案行化疗,16例行放疗。结果 19例获得平均4年2个月的随访,2例复发,2例死亡(1例为复发后再次手术患者)。结论 肿瘤切除彻底是四肢恶性软组织肿瘤保肢治疗的前提;放疗可以改善局部控制率;CVADIC方案是治疗恶性软组织肿瘤的可行方案;肿瘤切除后软组织缺损修复,应选择操作简单、就近取材、效果良好的方法。

Limb salvage for patients with malignant soft tissue tumor of the extremities

objective To explore the feasibity of the limb salvage operation in the malignant tumors of soft tissue. Methods Among the 22 cases of malignant tumors of soft tissue, there were 9 cases of synoviosarcoma,5 cases each of rhab-domyosarcoma and maligant fibrous histiocytoma, 2 cases of clear cell sarcoma, and 1 case of malignant xanthogranuloma. In 9 cases the lesions situated in the femoral region,4 in the gluteal region,3 cases each in the knee and heel regions and one case each in the lateral aspect of the leg ,the wrist and the foot. 16 cases were treated with surgery. Wide resection with skin flap transfer was done in other 6 cases. Chemotherapy with CVADIC was given postoperatively. Radiotherapy was instituted in 16 cases after operation. Results Follow-ups with the an average of 4 years and 2 months were done in 19 cases.Two cases had recurrance and two died. Conclusions The essential prerequisite for the limb salvage operation in cases of malignant soft tissue tumor is a radical resection of the tumor. Radiotherapy improved the rate of recurrance. The best choice for repairing the soft tissue defect is the use of skin flap transfer.