手部软组织肿瘤的显微外科治疗

目的探讨经显微外科技术切除手部软组织肿瘤后的复发率。方法对1994年至2003年,经手术治疗的手部各类软组织肿瘤81例的病史进行分析,并观察其复发率。81例中腱鞘巨细胞瘤33例,血管瘤23例,血管球瘤12例,神经鞘瘤4例,神经纤维瘤8例和恶性黑色素瘤1例。除1例恶性黑色素瘤将其周边5cm内的软组织一并切除外,另80例均在手术显微镜下将肿瘤完整切除。结果79例术后随访6个月～5年,2例失访。按单病种(血管瘤)算复发率为8.70%(2/23),按总数算复发率为2.53%。79例手功能恢复均良好,其中2例为海绵状血管瘤,于术后5个月和半年分别复发,经再次手术后随访1年3个月未见复发。结论手部软组织肿瘤,在手术显微镜下无创操作,逐层剥离,可以完整地切除瘤体,并减少肿瘤复发的因素。对恶性肿瘤周围软组织必定要按常规切除范围切除。

Microsurgical treatment of soft tissue tumors of the hand

Objective To look at the recurrance rate following microsurgical excision of soft tissue tumors of the hand. Methods 81 cases of soft tissue tumors of the hand surgically treated from 1994 to 2003 were reviewed. The recurrance rate was analysed. There were 33 cases of giant cell tumor of tendon sheath, 23 cases of hemangioma, 12 cases of glomus tumor, 4 cases of neurilemmona, 8 cases of neurofibroma, and 1 case of melanoma. The melanoma was surgically excised with 5 cm soft tissue margin. All other 80 cases were treated by tumor excision under surgical microscope. Results 2 cases were lost to follow up. 79 cases were followed for 6 months to 5 years. Recurrance was seen in 2 out of 23 cases of hemangioma, resulting in a 8.70% recurrance rate of this type of tumor. The overall recurrance rate was 2.53%. Recurrance of the tumor occurred at 5 months and 6 months postoperatively, respectively. Re-excision of the tumor was done. No recurrance was seen 1 year and 3 months following the second operation. Conclusion Excision of soft tissue tumors of the hand under surgical microscope can achieve atraumatic clear dissection and intact excision of the tumor that leads to reduced recurrance. Standard extended excision, however,should be carried out for malignant tumors.