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1.
In the past, sarcomas located in the iliac fossa, in the area over the external iliac vessels, or those in the lesser pelvis with fixation to the lateral wall, were inaccessible through the conventional abdominal incisions, mainly due to a lack of distal exposure. They were often called unresectable or were dealt with by an external hemipelvectomy. The abdominoinguinal incision provides exposure in one continuous field of the lower abdomen and the groin area on the side involved by the tumor, or bilaterally, if needed. It provides control of the vessels proximally and distally and easy identification of the femoral nerve lateral to the femoral artery. A simplified version in the form of an L or a reverse T through transection of the ipsilateral/bilateral rectus abdominis off the pubic crest provides a significantly improved exposure for low pelvic tumors in the midline. This affords the opportunity to perform under direct vision dissection in the area of the obturator nodes and obturator foramen, as well as exposure of the distal portion of the external iliac artery and vein. The technique of internal hemipelvectomy and sacral resection for tumors involving any part of the innominate bone or the sacrum, respectively, also amplify the surgical armamentarium in the resection of pelvic tumors with pelvic wall fixation. These incisions, although developed in the management of soft tissue sarcomas of the pelvis, are applicable for other histologic types of cancer when the biology and stage of the tumor are supportive of surgery for the pelvic disease.  相似文献   

2.
Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL) disease, was referred to our Department because of the occurrence of a hard lump at the right aspect of the pelvis, who presented a primary mildly differentiated chondrosarcoma of the right iliac wing (confirmed by CT scan). Chondrosarcoma of the iliac wing, treated by surgical resection and reconstruction of the pelvis with appropriately shaped bone allograft fixed with plates and screws. At one year follow-up, the patient shows no signs of recurrence. Conventional treatment for chondrosarcoma of the iliac wing would be either wide or radical resection (hemipelvectomy), or amputation. The described treatment is unusual in that it is dependent on patient's choice to privilege quality of life due to the awareness of being affected by a genetic disease with an inauspicious prognosis.  相似文献   

3.
Very large bone and soft tissue tumors located in the pelvis or upper thigh may require hemipelvectomy if local excision is not possible. Classical hemipelvectomy is associated with a high risk of local complications and usually with a poor functional result. This paper describes a modified hemipelvectomy where the preservation of the upper iliac wing provides a counterpressure for the external prosthesis, and a vascularized anterior musculo-cutaneous thigh flap decreases the risk of skin necrosis and wound problems.  相似文献   

4.
Sarcomas of the pelvic girdle represent difficult treatment problems. Many are not treatable for cure, and among the patients who are technically resectable, there is high risk for local tumor recurrence and distant spread. Intraoperative radiotherapy (IORT) has been used in conjunction with surgical resection in five patients with extensive sarcomas of the pelvic girdle. Patients underwent a hemipelvectomy and IORT (dose 20–30 Gy) to the sacral resection margin and surrounding soft tissues. Three patients developed pulmonary metastases within 3 months and eventually died from metastastic disease (8–38 months). Two patients have remained disease-free (43 and 53 months). Four patients (80%) have remained locally free of tumor with follow-ups of 8–53 months. The only treatment complication was late osteonecrosis of the coccyx which appeared 7 months after treatment. By contrast, six historical control patients with sarcomas of the pelvic girdle treated with resection alone showed a local control rate of only 27% over a 40-month follow-up. On the basis of this preliminary experience, it appears that IORT may substantially help to control local disease in patients with grossly resectable sarcomas of the bony pelvis.  相似文献   

5.
AIM: To evaluate the efficiency of our follow-up regime for patients with sarcoma of the extremities. METHODS: We have reviewed our follow-up policy in 480 patients with non-metastatic bone or soft tissue sarcomas and with more than 5 years of follow-up. RESULTS: We detected 24% of the soft tissue sarcoma recurrences and 38% of the bone tumour recurrences. We detected 67% of the pulmonary metastases before they became symptomatic. Only 11% of those patients who developed metastases were cured, as were only 26% of those who developed local recurrence. CONCLUSIONS: This study shows that our surveillance programme detects most metastases, but only about one third of the local recurrences.  相似文献   

6.
AIMS: To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to define the guidelines for appropriate treatment. METHODS: We reviewed 60 consecutive patients with primary pelvic high-grade osteosarcoma. The tumour involved the whole hemipelvis in 15 cases, while the most common location was the iliac wing in 29 cases (48.3%): 25 of these adjacent to or passing the sacroiliac joint. RESULTS: Thirty patients underwent surgery; there were 16 hindquarter amputations and 14 internal hemipelvectomies. All the patients who presented with metastasis died of their disease. In 18 cases wide margins were achieved, however, eight patients experienced local recurrence. Of the series, only eight patients are still alive. CONCLUSION: The use of intense chemotherapy and surgical wide margin, hardly seems to achieve local control, however, tumour necrosis was correlated with positive prognosis. When internal hemipelvectomy it is not safe enough, amputation must be considered, particularly for cases with sacrifice of the sciatic nerve roots or for older patients where a shorter surgical procedure can be less risky.  相似文献   

7.
Pelvic sarcomas are a rare and heterogenous group of tumors divided into two groups: soft tissue sarcomas and bone sarcomas. Soft tissue sarcomas of the pelvis include most commonly liposarcoma, leiomyosarcoma, gastrointestinal stromal tumors, malignant peripheral nerve sheath tumors, and solitary fibrous tumors. Bone sarcomas of the pelvis most commonly include osteosarcoma and chondrosarcoma. Multidisciplinary treatment at a center experienced in the treatment of sarcoma is essential. Management is dictated by histologic type and grade. Surgical resection with wide margins is the cornerstone of treatment for pelvic sarcomas, although this is often challenging due to anatomic constraints of the pelvis. Multimodal treatment is critical due to the high risk of local recurrence in the pelvis.  相似文献   

8.
The authors have reviewed 22 cases of proximal disarticulations with the aim of assessing the therapeutic value, taking into account previous radio- and chemotherapy. The following criteria were especially examined: recurrences, survival, quality of life. There were 13/22 soft tissue sarcomas, 9/22 bone sarcomas. In 10 instances, the tumour was primary and treated for the first time whilst, in 12 cases, it was recurrence. Eighteen patients had been previously treated by non radical surgery, 11 by radiotherapy and 10 by chemotherapy. For upper limb tumours, six patients underwent an inter-scapulo-thoracic disarticulation and three an inter-scapulo-thoracic resection according to Tykhor-Lindberg. For lower limb tumours, seven patients were submitted to inter-ilio-abdominal disarticulation, three to coxo-femoral disarticulation and one to internal hemipelvectomy according to Eilber. Mean disease free interval has been 34.5 months and mean survival 38.5 months. Three out of 20 evaluable patients (15%) recurred locally although most of them benefited from second surgery. Quality of life has been excellent in general despite the fact that only seven patients accepted wearing a prosthesis. Karnofsky index ranged between 60 and 100%. No significant difference was seen, whether or not previous radiotherapy and/or chemotherapy had been administered.  相似文献   

9.
Internal hemipelvectomy is a nonamputative operation indicated for tumors arising in the iliac bone. The technique is dificult and complex and requieres a great experience with this type of surgery. The rehabilitation is a need after surgery. Internal hemipelvectomy can be total or partial when the whole or part of tlie iliac bone is resected. We report our expen ence with fifteen cases; six of them were chondrosarcomas, the most frequent indication for this type of surgery. The surgical technique is described with the personal modifications used in our cases. Complications are frequent (46.6%), similar to other series. Rehabilitation is more difficult and time consuming with total internal hemipelvectomy than with a partial operation. In these cases function is much better than when we resect the whole bone. Five patients had local recurrences, all of them resected with longterm survival. Two patients developped multiple pulmonary metastases; one died and the other had pulmonary resections with long term survival. Five out of fifteen patients survived more than ten years, two with benign tumors (osteclastomas). After the acceptable oncologic and functional results obtained in this series we recomend this operation in selected cases.  相似文献   

10.
AIMS: Limb salvage surgery combined with tumour resection has become established in the management of pelvic tumours. However, subsequent reconstructive options for maintenance of quality of life lead to varied outcomes. We present a hitherto undescribed use of the Ilizarov technique as a second stage adjunct, for the optimisation of function, after first stage tumour resection and arthrodesis. METHODS: We describe the surgical technique used to address leg length discrepancy and abductor dysfunction following internal hemipelvectomy with ischifemoral arthrodesis. Distal femoral and distal tibial lengthening using circular frames, with a valgus subtrochanteric femoral osteotomy, enabled a rapid correction of both anomalies. Controlled varus correction at the distal femoral osteotomy site was performed to obtain a horizontal joint line at the knee. CONCLUSION: The Ilizarov technique is suitable for selected patients with tumour free survival following the initial resection. Our experience indicates that it is a good alternative to a mammoth one stage internal hemipelvectomy with reconstruction. The latter is often attempted even though there is a high risk of local recurrence and distant metastasis.  相似文献   

11.
Extracorporeal irradiation for malignant bone tumors   总被引:3,自引:0,他引:3  
PURPOSE: Extracorporeal irradiation (ECI) has been used selectively in the management of primary malignant bone tumors since 1996. We report our techniques for ECI and the short-term oncologic and orthopedic outcomes. METHODS AND MATERIALS: Sixteen patients with primary malignant bone tumors were treated with ECI from 1996 to 2000. The median age was 14 years. The histologic diagnoses were Ewing's sarcoma (11), osteosarcoma (4) and chondrosarcoma (1). The treated sites were femur (7), tibia (4), humerus (2), ilium (2), and sacrum (1). Following induction chemotherapy in Ewing's sarcomas and osteosarcoma, en bloc resection of the tumor and tumor-bearing bone was performed. A single dose of 50 Gy was delivered to the bone extracorporeally using either a linear accelerator (9 cases) or a blood product irradiator (7 cases). The orthopedic outcome was recorded using a standard functional scale. RESULTS: At a median follow-up of 19.5 months, there were no cases of local recurrence or graft failure. One patient required amputation due to chronic osteomyelitis. For the 10 patients with follow-up greater than 18 months, the functional outcomes were graded good to excellent. CONCLUSION: The short-term oncologic and orthopedic results are encouraging and suggest that ECI provides a good alternative for reconstruction in limb conservative surgery in selected patients. This technique should only be used in a multidisciplinary setting, where careful follow-up is available to assess the long-term outcomes.  相似文献   

12.
目的总结骨盆软骨肉瘤的手术切除、重建、并发症和疗效。方法回顾性分析手术治疗的21例骨盆软骨肉瘤患者的临床资料。其中男性9例,女性12例;年龄16~65岁,中位年龄46岁。根据Ennek ing骨盆肿瘤分区:Ⅰ区2例,Ⅰ和Ⅱ区5例,Ⅱ区6例,Ⅱ和Ⅲ区7例,Ⅲ区1例。高分化软骨肉瘤12例,中分化软骨肉瘤5例,低分化软骨肉瘤2例,间叶性软骨肉瘤2例。肿瘤刮除灭活+异体骨植骨2例;髂骨翼大块切除+钉棒系统重建1例;髂骨大块切除+异体肱骨螺钉重建1例;耻骨切除自体髂骨移植钢板螺钉重建1例;半骨盆截肢2例;内半盆切除5例;围髋臼切除重建9例。结果21例患者随访时间7-100月,平均39月。17例患者无瘤生存,2例带瘤生存,2例死亡。16例行广泛切除术中5例局部复发,5例行边缘性和经病灶切除术中3例局部复发。软骨肉瘤的复发率为38.1%,死亡率为9.5%。19例生存患者参加功能评价,根据国际保肢学会功能评分系统,总分7~25分,平均19分。8例患者术后出现可控性并发症。结论骨盆软骨肉瘤治疗首选广泛性切除,积极预防和处理并发症是保证手术成功的关键。  相似文献   

13.
10 patients underwent hemipelvectomy, mainly for sarcomas originating high in the thigh, or melanomas and epidermoid carcinomas metastatic to the groin. 1 patient died postoperatively, 3 lived 5-12 years and 1 died of unrelated cause 2 years after the operation, all free of recurrence. Tumors treated successfully were large and with indolent locoregional growth, often despite repeated unsuccessful local treatment attempts. These tumor characteristics should be considered as favorable features, in selecting such patients for hemipelvectomy. Conversely 3 patients with melanoma had short history before and died soon after the operation, contraindicating hemipelvectomy in locally advanced melanoma.  相似文献   

14.
BACKGROUND: Soft-tissue sarcomas frequently rest in contact with bone. The purpose of the study was to evaluate the risk of local recurrence for sarcomas adjacent to bone and to determine whether the periosteum provides an adequate margin of resection. METHODS: Fifty patients with soft-tissue sarcomas abutting bone were treated at a single institution between 1990 and 2004. All patients had high-grade, T2 (>5 cm), nonmetastatic disease in the lower extremity. Bone contact was verified by preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) scans. Forty-three of 50 patients received preoperative radiation with a mean dose of 50 Gy. In 11 cases a composite resection of bone and soft tissue was performed. In 39 cases the excision involved only soft tissue. RESULTS: True bone invasion was verified by histopathologic examination in 3 of 50 cases (6%). Local recurrence in the soft tissues developed in 8 of 50 (16%) patients. In no case did the recurrence involve destruction of cortical bone or erosion into bone. The recurrent tumor resided against the region of previous bone contact in 1 of 8 cases. There was no statistically significant difference in local recurrence between patients who had composite bone resection and patients who had soft-tissue resection only (P = .87). CONCLUSIONS: Relatively few sarcomas are able to penetrate cortical bone. Composite bone and soft-tissue resections are indicated primarily for frank bone invasion. In the absence of this, the periosteum is an adequate surgical margin for sarcomas treated with wide excision and radiation.  相似文献   

15.
BACKGROUND: The surgical treatment of chondrosarcoma of the pelvis, sacrum, and spine is complex and technically demanding. As such, adequate surgical margins have been difficult to achieve, resulting in poor local control and survival. The objective of this study was to assess the outcome of patients with chondrosarcomas in these sites who were treated at a tumor center by using modern, aggressive surgical techniques and to identify prognostic factors. METHODS: Sixty-nine consecutive patients with chondrosarcoma of the pelvis (46 cases), sacrum (11 cases), and mobile spine (12 cases) who were treated at Sahlgrenska University Hospital from 1967 to 1999 were included in this study. Demographic information and follow-up data were obtained and statistically analyzed. RESULTS: There were 53 men and 16 women with a mean age of 45 years and a mean tumor size of 12 cm. There were 61 conventional chondrosarcomas, Grades 1-3 (with 13 arising in a preexisting osteochondroma) and 8 Grade 4 chondrosarcomas (7 dedifferentiated and one mesenchymal). The overall local recurrence rate was 27%, and the estimated overall 5- and 10-year survival rates were 72% and 67%, respectively. In contrast, the observed local recurrence rate was 3% (1 patient) in 31 patients whose conventional chondrosarcomas were resected with adequate surgical margins; 90% of these patients survived and most of them (26 of 31 or 84%) were continuously disease free. Significant factors associated with a worse prognosis with respect to local control and/or survival were high histologic tumor grade, increasing patient age, primary surgery outside of a tumor center, incisional biopsy versus a noninvasive diagnostic procedure, and inadequate surgical margins. CONCLUSIONS: Center-based diagnosis and treatment using modern aggressive surgical techniques significantly improve the prognosis of patients with chondrosarcoma of the pelvis, sacrum, and spine.  相似文献   

16.
目的:研究骶骨原发尤文肉瘤的临床特点、治疗方式及预后。方法1998年6月至2011年6月,对收治的15例骶骨原发尤文肉瘤进行回顾性分析。男9例,女6例,其年龄11~45岁,平均18岁。所有患者术前均有骶尾部疼痛症状,11例伴有会阴区麻木、下肢疼痛等神经症状,3例可触及局部肿块。侵及单个节段者2例,累及2个节段及以上者13例。术前X线片及CT提示骶椎多呈不规则溶骨性破坏,CT和MRI 检查经常可见巨大的软组织肿块。所有患者均行系统化疗及手术治疗,10例于术后接受放疗。9例行骶骨肿瘤分块切除、重建术,6例行整块切除术,其中4例行一期前后路联合全骶骨切除重建术。结果术后随访2~10年。平均5.2年。所有患者局部疼痛均得到缓解。围手术期并发症5例,其中伤口并发症4例。11例均存在不同程度大小便功能障碍。在随访期内出现肿瘤局部复发及转移10例,局部复发9例(9/15,60%),肺转移5例(5/15,33.3%),其中包括局部复发伴肺转移4例。其中行肿瘤整块切除6例中骶骨局部复发1例,局部复发伴肺转移1例。转移及局部复发时间7个月至5年,局部复发及转移者中全部10例均接受二线治疗。至末次随访已死亡9例,2例带瘤生存。2年无瘤生存率60%,5年无瘤生存率33.3%,5年总生存率为47%。结论骶骨原发尤文肉瘤是一类高度恶性的肿瘤,必须采取手术、放疗和化疗相结合的综合治疗模式。骶骨肿瘤术后并发症较多。骶骨肿瘤整块切除术是对于骶骨原发高度恶性肿瘤的重要局部治疗方法。  相似文献   

17.
Limb sparing surgery has replaced amputation surgery for treating sarcomas of the lower limb in most cases. Wide resection followed by postoperative radiation therapy can achieve acceptable local control and survival rates in patients with bone and soft-tissue sarcomas of the lower limb. Recurrent or persistent disease constitutes a major oncological problem. Local symptoms such as agonizing pain, fractures, tumor fungation, inability to walk and inability to maintain daily activities, further impair the patient's quality of life. In this clinical set-up palliative amputation of the limb should be considered. Fourteen patients with soft-tissue or bone sarcomas underwent palliative major amputation. The procedures included: hemipelvectomy, hip disarticulation, knee disarticulation, above or below-knee amputation. Local control of the disease and pain, and improvement of the performance status were observed in 13 evaluable patients. The mobility was restored in 13/14 patients. The median survival following the procedure was 9 months. There was only one case of immediate post-operative death. Severe phantom pain was not reported by any of the patients. Quality of life was reported to be improved by two-thirds of the patients. We found palliative major amputation surgery worth-performing in low-performance status cancer patients with locally advanced disease of the lower limb.  相似文献   

18.
目的探索侵犯关节周围骨组织的肢体软组织肉瘤的外科手术方法,并分析术后并发症、肢体功能和患者的生存状况。方法回顾性分析2004年5月至2011年10月期间,我中心所收治的30例局部侵犯关节周围骨组织的软组织肉瘤患者的临床资料。其中男14例,女16例,平均年龄51岁(17~75岁)。恶性纤维组织细胞瘤12例,脂肪肉瘤8例,原始神经外胚层肿瘤(PNET)4例,滑膜肉瘤、腺泡状软组织肉瘤和恶性神经鞘瘤2例。其中10例发病位于股骨近端,9例股骨远端,8例肱骨近端,2例胫骨近端,1例累及整个股骨。所有患者均采取了肿瘤连同受累骨组织一起广泛切除、以肿瘤型假体重建骨缺损的手术方式。术后定期复查患肢功能、x线片、肺CT等,并且密切随访,内容包括术后并发症的发生情况、肢体功能恢复情况及肿瘤学与生存状况等。结果平均随访25个月(3—84个月),1例暂时性腓总神经麻痹;3例术后伤口愈合不良行清创手术,其中1例因深部感染不愈而截肢;2例假体断裂行翻修手术;4例肿瘤复发,局部复发率13.3%,其中1例接受截肢手术。总的肺转移为15例,且11例死亡患者中均为肺转移,其中3例合并骨转移。至最后一次随访时14例无瘤生存,5例带瘤生存,平均MSTS评分股骨近端90%,股骨远端82%,胫骨近端73%,肱骨近端71%,全股骨为60%。2年和5年生存率分别为61.6%和30.8%。结论将受累骨组织和肿瘤一起广泛切除可获得无瘤边界,降低复发率,骨缺损采用肿瘤型假体重建可恢复良好的肢体功能。巨大肢体软组织肉瘤侵犯骨组织可能是患者预后不良的因素。  相似文献   

19.
AIM: To report the complication rates of limb-salvage reconstruction in the pelvis. Detailed analyses about the type, treatment and outcome of post-operative complications, various reconstruction options are presented. METHODS: Factors that might influence the occurrence of complications were evaluated of 50 consecutive surgically treated patients. RESULTS: The mean follow-up was 57 months. Limb-salvage procedures were used in 42/50 patients, amputations in 8/50 patients. After limb-salvage procedures complications occurred in 32/42 patients, after hemipelvectomy in 6/8 patients. The 1 and 5-year overall survival rate was 92 and 68%, respectively. CONCLUSION: There is a high complication rate in reconstructive techniques using hemipelvic autografts and/or allografts. These procedures are appropriate only in well selected patients. The complication rates following endoprosthetic reconstruction are comparably low.  相似文献   

20.
PURPOSE: To evaluate the tolerance for and effectiveness of carbon ion radiotherapy in patients with unresectable bone and soft tissue sarcomas. PATIENTS AND METHODS: We conducted a phase I/II dose escalation study of carbon ion radiotherapy. Fifty-seven patients with 64 sites of bone and soft tissue sarcomas not suited for resection received carbon ion radiotherapy. Tumors involved the spine or paraspinous soft tissues in 19 patients, pelvis in 32 patients, and extremities in six patients. The total dose ranged from 52.8 to 73.6 gray equivalent (GyE) and was administered in 16 fixed fractions over 4 weeks (3.3 to 4.6 GyE/fraction). The median tumor size was 559 cm(3) (range, 20 to 2,290 cm(3)). The minimum follow-up was 18 months. RESULTS: Seven of 17 patients treated with the highest total dose of 73.6 GyE experienced Radiation Therapy Oncology Group grade 3 acute skin reactions. Dose escalation was then halted at this level. No other severe acute reactions (grade > 3) were observed in this series. The overall local control rates were 88% and 73% at 1 year and 3 years of follow-up, respectively. The median survival time was 31 months (range, 2 to 60 months), and the 1- and 3-year overall survival rates were 82% and 46%, respectively. CONCLUSION: Carbon ion radiotherapy seems to be a safe and effective modality in the management of bone and soft tissue sarcomas not eligible for surgical resection, providing good local control and offering a survival advantage without unacceptable morbidity.  相似文献   

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