危险区骨骼肌肉系统肿瘤的外科治疗

目的:介绍一种安全处理危险区骨骼肌肉系统良性或低度恶性肿瘤的外科治疗方法。方法:对骶2脊索瘤先施行前路经腹结扎双侧髂内动脉,然后再切除肿瘤,可减少出血。对腹股沟区或腘窝区较大肿瘤与股、腘大血管及神经紧密粘连者,先从肿瘤远近端血管、神经正常部分解剖出血管神经,再向病变区解剖,容易完整切除肿瘤。对锁骨上区肿瘤,先截除一段锁骨,然后从肿瘤远近端正常锁骨下动、静脉及臂丛神经处,向肿瘤部游离并保护好胸膜,可较安全地切除肿瘤。而对于腓骨头、颈及其周围部肿瘤,先解剖出腓总神经及其各肌支,尽可能保留肌支。结果:11例危险区(紧邻大血管、神经区域)良性或低度恶性骨骼肌肉系统肿瘤,采用先从肿瘤远近端正常血管、神经处游离出神经、血管,再向肿瘤部解剖,均顺利解剖出大血管及神经,并完整切除肿瘤。所有病例无复发,亦无肢体功能障碍。结论:对紧邻重要血管及神经的较大良性或低度恶性骨骼肌肉系统肿瘤,先从正常段血管、神经向肿瘤部解剖游离,既可彻底切除肿瘤,又可避免损伤血管、神经引起肢体功能障碍,是一种较好方法。

The surgical treatment of musculo- skeletal tumors in dangerous region

Objective:To introduce a surgical treatment of the innocent or low-degree malignant musculo-skeletal tumors in dangerous region.Methods: For the sacral 2 chordoma,to perform the ligation of the two-side internal iliac artery first through abdominal cavity and then excise the tumors in order to reduce bleeding.For the large tumors especially adhering tightly with important nerves and vessels in inguinal region or popliteal fossa,to dissect first the normal vascular nerve of tumors distantly and proximally and then disconnect the lesion for excision of tumors completely.For the tumors in supraclavicular region,to dissect the normal vascular nerve of infraclavicula and brachial plexus of tumors distantly and proximally,at the same time protecting the pleura after cutting a 6cm-clavicle,and then disconnect the lesion for excision of tumors completely and safely.While for the tumors in fibular head and neck as well as its surrounding region,to dissect first the common peroneal nerve and preserve its muscular branches.Results: Using this method,we treated 11 patients.All cases had no recurrence and limbs disturbance after follow-up.Conclusion: Dissecting first the normal vascular nerve of tumors distantly and proximally and then disconnecting the lesion for excision of tumors is a better choice for the large tumors of the innocent or low-degree malignant musculo-skeletal tumors especially adhering tightly with important nerves and vessels because of avoiding recurrence and limbs disturbance caused by injury of vascular nerve.