上肢软组织恶性肿瘤的手术治疗和预后

目的 总结10年来上肢软组织恶性肿瘤的分类、发生、发展、治疗及预后。方法 对22例上肢软组织恶性肿瘤，采用手术治疗将肿瘤及边缘的正常组织一并切除，尽量保留肢体及其重要血管和神经，以保存上肢功能。行神经移植修复3例，带蒂皮瓣覆盖创面8例。对10例复发病例再次切除肿瘤组织后，进行化学治疗和放射治疗等综合治疗。结果 术后随访最短3个月，最长10年半，平均5年；其中2例滑膜肉瘤于术后1年因远处转移而死亡，其余病人无远处转移。5年生存率为87．5％，生存5年以上者共14例。局部复发14例，复发率为70％；由于多次复发最终上肢截肢1例，手指截指2例，肢体保存率为85％。结论 上肢软组织恶性肿瘤以手术治疗为主，辅以化学治疗和放射治疗等综合治疗。

Surgical treatment and prognosis of soft tissue malignant tumors in upper extremity

Objective To summarize the classification, development, progress, treatment and prognosis in softtissue malignant tumor in upper extremity in recent 10 yeare. Methods Twenty-two upper limb soft tissue malignanttumors were involved in the study. The treatment included surgical excision of the tumor and its surrounding tissue. Thelimbs length and their main vessels and nerves were kept as intact as possible for preservation of upper extremity. Therewere nerve graffing 3 cases and wound coverage with pedicled flap 8 cases. Chemotherapy and radiotherapy was carroedout in 10 recurrent cases after re-excision of the tumor. Results The postoperative follow-up ranged from 3 months to10.5 years with an average of 5 yeare. Among them 2 cases of synovial sarcoma died of distant spread at postoperative1 year. Others had no metastasis. The 5 year survival rate was 87.5% (14cases). Local recurrence was found in 14cases with a recurrent rate of 70%. Due to recurrence for many times, there was upper extremity amputation in onecase and finger amputation in 2 cases, with the preservation rae of 85%. Conclusion The upper extremity soft tissuemalignant tumors are mainly treated by surgical excision, combined with chemotherapy and radiotherapy.