肩胛带巨大软组织肉瘤的外科治疗

目的 探讨肩胛带巨大软组织肉瘤的外科治疗特点和影响治疗效果的各种因素.方法 2005-2009年我科治疗7例肩胛带巨大软组织肉瘤患者,男性4例,女性3例.7例均为术后复发患者.年龄14 ～75岁,平均43.8岁.肿瘤最大径10～ 16 cm.所有患者均行手术治疗,其中广泛切除4例,边缘切除3例.5例患者行肿物局部切除背阔肌肌瓣转移取皮植皮术,1例患者行局部推进皮瓣术,另1例患者行肿物局切取皮植皮术.术后病理:3例恶性纤维组织细胞瘤、1例低度恶性黏液性纤维肉瘤、1例原始神经外胚层瘤、1例腺泡状横纹肌肉瘤、1例皮肤隆突性纤维肉瘤.术后采用国际肌肉骨骼系统肿瘤协会(MSTS)标准进行肩关节功能评分.结果 7例患者得到长期随访,平均随访时间29个月(10 ～46个月).2例患者有局部复发,其中1例再次术后6个月肺转移死亡;1例患者有肺转移;其余4例患者无复发及肺转移.术后患者肩关节功能满意,MSTS评分28分.结论 肩胛带软组织肉瘤在早期常被误诊误治,广泛的外科边界是控制局部复发的主要因素.外科边界和病变的侵袭性是肩胛带软组织肉瘤预后的主要影响因素.手术造成的巨大软组织缺损常需局部肌瓣或皮瓣转移来修补,常用背阔肌肌瓣转移.

Surgical treatment of massive soft tissue sarcoma in the shoulder girdle

Objective To detect the character of surgical treatment of massive soft tissue sarcoma in the shoulder girdle and analyze the impact factor to the result.Methods Seven patients with massive soft tissue sarcoma in the shoulder girdle were treated in our department between 2005 and 2009.There were 4 males and 3 females.All the patients were referred to our hospital after local recurrence post-operatively.The mean age was 43.8 years old (range 14-75).The maximum diameter of the tumor varied from 10 to 16 centimeters.All the patients were performed surgery,wide margin in 4 cases and marginal margin in 3 cases.Five were performed tumor resection and reconstruction with latissimus dorsi muscle flap transfer and skin graft.One was reconstructed with advanced skin flap and skin graft.The other one was treated with skin graft.The diagnosis included 3 malignant fibrous histiocytomas,1 low grade myxoid fibrosarcoma,1 Primitive neuroectodermal tumor,1 rhabdomyosarcoma,1 dermatofibrosarcomas protuberans.The MSTS score system was used to evaluate the shoulder function.Results Seven patients were followed up with long time.The mean follow up was 29 months ( range 10 to 46 mouths).Two patients suffered local recurrence and one died of pulmonary metastasis 6 months after the second surgery for local recurrence.One patient suffered pulmonary metastasis.The last four patients were disease-free at the end of follow-up.The function of shoulder girdle was satisfactory.The mean MSTS score was 28.Conclusions Soft tissue sarcomas in the shoulder girdle are easy to be misdiagnosed and mistreated.Wide surgical margin was the key impact factor to the local recurrence of soft tissue sarcoma in the shoulder girdle.The surgical margin and invasion of the tumor are the key factor to the prognosis.The soft tissue defect after surgery is often reconstructed by muscle flap transfer or skin flap transfer.The latissimus dorsi muscle flap transfer is often used.