320排CT血管造影在肢体软组织肉瘤治疗中的作用

目的评估320排CT血管造影（CT angiography,CTA）及三维重建成像对肢体软组织肉瘤手术的指导价值。方法 2008年5月-2010年12月对23例肢体软组织肉瘤行320排CTA检查,观察肿瘤与周围血管、组织器官的关系。其中男10例,女13例,年龄10～65岁（平均38岁）。肿瘤分类：恶性纤维组织细胞瘤7例,滑膜肉瘤5例,脂肪肉瘤4例,横纹肌肉瘤2例,原始神经外胚层瘤2例,恶性黑色素瘤2例,恶性神经鞘瘤1例。结果 320排CTA能清楚显示肿瘤的形态及其与邻近大血管、组织器官的关系。23例患者中7例行广泛切除术,16例行边缘切除术。其中2例肿瘤位于腘窝的患者,CTA显示肿瘤包绕腘动脉,术中将血管切除后行大隐静脉重建。随访10～40个月（平均24个月）,8例复发,复发率34.8%。结论 320排CTA能提供肢体软组织肉瘤与邻近血管及器官组织的三维空间图像,是手术入路选择和术中血管处理的重要依据,有助于制定手术方案、减少并发症和保证疗效。

Clinical value of 320-row CT angiography in treatment of limb soft tissue sarcoma

Objective To evaluate the clinical value of 320-row CT angiography （CTA） in the surgery of limb soft tissue sarcoma （STS）. Methods From May 2008 to December 2010, 23 patients with limb STS treated in our hospital underwent 320-row CTA. This group had 10 male and 13 females with the average age of 38 years （10-65 years）. There were 7 cases Of malignant fibrous histiocytoma, 5 cases of synovial sarcoma, 4 cases of liposarcoma, 2 cases of rhabdomyosarcoma, 2 cases of melanoma and 1 case of malignant nerve sheath primitive neuroectodermal tumor, 2 cases of malignant tumor. Results The 320-row CTA provided clear three-dimensional images of the STS, and showed distinct relations between STS and adjacent vessels or surrounding tissue and organs. In 23 patients, wide resection performed in 7 cases while marginal resection in 16 cases. Two cases with popliteal fossa tumors whose CTA showed that the popliteal artery were encased underwent vascular resection and saphenous vein reconstruction. All patients were followed up from 10 to 40 months （average, 24 months）, 8 recurrent cases were found with the recurrent rate was 34.8%. Conclusions The 320-row CTA, being able to provide three-dimensional images of the STS, and to demonstrate its relations with the adjacent vessels and tissues, can supply the vital information to choose the proper surgical approach and to manage the vasculature during the operation to decrease complication and to improve therapeutic effects.