锁骨后方软组织侵袭性肿瘤的手术治疗分析

目的 探讨锁骨切开入路手术治疗锁骨后方侵袭性肿瘤的可行性、安全性及其临床应用价值。方法 回顾性分析2014年1月—2017年1月复旦大学附属肿瘤医院骨软组织外科收治的12例锁骨后方软组织侵袭性肿瘤患者的临床资料,其中男5例、女7例,年龄18~74岁;黏液纤维肉瘤4例,侵袭性纤维瘤4例,肌纤维母细胞瘤2例,骨外骨肉瘤1例,高级别梭形细胞肉瘤1例。肿瘤长径为4~12 cm(中位数为8 cm)。均行锁骨切开+软组织肿瘤切除+锁骨复位钢板螺钉内固定术治疗,术中锁骨劈开位置均位于锁骨中1/3段,术后三角巾制动4~6周。手术并发症按T94分级系统评价,手术前后患肢功能以肌骨肿瘤学会(MSTS)评分标准进行评价。结果 本组12例患者肿瘤均得以完整切除,切缘R0为10例、R1为2例,未见手术相关并发症发生。术后均获随访,随访时间12~38(中位数为24)个月。术前患肢功能MSTS评分中位数为28分,术后6个月时评分中位数为28分。局部复发2例(分别为术后2个月和3个月复发),其中1例骨外骨肉瘤患者复发同时发现了脑转移,术后20个月死亡。结论 锁骨切开入路可安全应用于锁骨后方软组织侵袭性肿瘤的切除,术后患侧肢体功能良好,肿瘤控制满意。

Surgical treatment of soft tissue tumors with locally invasive growth pattern or sarcomas posterior to the clavicle

Objective To investigate the feasibility and safety of trans-clavicle approach for resection of neck tumors posterior to clavicle.Methods The clinical characteristics, imaging features, pathological findings and treatment modalities were retrospectively collected from the prospective database of Fudan University Shanghai Cancer Center from January 2014 to January 2017. Twelve patients(7 males and 5 females) were enrolled in the study, aged from 18 to 74 years. There were 4 myxofibrosarcomas, 4 desmoid fibrosis, 2 myofibroblastic tumors, 1 extraesseous osteosarcoma and 1 high grade spindle cell sarcoma. The tumor had a long diameter of 4 to 12 cm (median value is 8 cm).All patients underwent clavicle incision, soft tissue tumor resection and clavicular reduction plate internal fixation. The split position of clavicle was in midshaft 1/3. The triangular towel was fixed for 4-6 weeks after operation. Postoperative complications were evaluated by T94 grading system, and postoperative function was evaluated by musculoskeletal tumor score(MSTS).Results All the tumors were resected completely by en bloc with R0 margin in 10 cases, R1 in 2 cases.There were no severe surgical complications.the median follow-up was 24 months(12-38 months). The average MSTS of limb function was 28 before operation, and the average MSTC of limb function was 28 at 6 months after operation. Local recurrence occurred in 2 cases (recurrence of 2 months and 3 months after surgery), including 1 case of extra-osseous osteosarcoma, recurrence with brain metastasis, died 20 months after surgery.Conclusions The clavicle incision can be safely applied to the soft tissue invasive neoplasms and sarcoma resection behind the clavicle, with good postoperative limb function and satisfactory tumor control.