上肢腱鞘巨细胞瘤术后复发相关因素分析

摘要

目的:了解上肢腱鞘巨细胞瘤患者的性别、年龄、肿瘤生长部位、术中化学处理情况和肿瘤术后复发的相关性.方法:回顾分析2000年1月至2011年8月47例上肢腱鞘巨细胞瘤住院患者的病史,对其性别、年龄、肿瘤生长部位、术中是否接受化学灭活处理、手术并发症、肿瘤复发情况及病理结果做统计和分析.本组女28例,男19例；年龄17～78岁,平均38.15岁.所有病例接受手术局部切除.14例术中使用化学方法灭活肿瘤细胞(术中使用乙醇或碘酒浸泡手术创面).对患者定期随访,观察创口愈合情况、病理结果、肿瘤是否复发,并做必要的影像学检查.结果:47例平均随访53.89个月(22～129个月),其中4例术中采用乙醇灭活的病例术后出现创口红肿、坏死组织排出、创口延迟愈合等并发症；15例报告肿瘤组织生长活跃,1例为低度恶性的腱鞘巨细胞瘤.术前X线发现有骨质破坏组术后复发率明显增高(P=0.003)；术中接受化学方法灭活的病例术后复发率小于未接受化学方法灭活病例(P=0.042).结论:上肢腱鞘巨细胞瘤患者术后是否复发与肿瘤生长部位、是否有骨质破坏、是否采取术中化学灭活密切相关.局部切除是治疗上肢腱鞘巨细胞瘤的有效方案,配合术中化学方法灭活能够降低术后复发风险.如何在术中确定复发高危人群,降低其复发率及重建广泛切除肿瘤后的手功能是将来研究的重点和难点.%Objective:To study the relation of the sex,age,location and chemotherapy with recurrence of the tumor. Methods: From January 2000 to August 2010,47 patients with giant cell tumor of tendon sheath in upper extremity were retrospectively analyzed. Statistical analysis of sex,age at presentation,lesion location,chemical inactivation,surgical complications, tumor recurrence and pathological findings were explored. There were 28 females and 19 males,ranging in age from 17 to 78 years, with an average of 38.15 years. All the patients underwent surgical excision. Fourteen patients received intraoperative chemically inactive treatment. All the patients had routine follow-up to observe the wound healing,pathological findings,tumor recurrence,and received necessary imaging examinations. Results:All the patients were followed up,and the duration ranged from 22 to 129 months,with a mean time of 53.89 months. Four patients who received intraoperative alcohol inactivation appeared wound complications such as wound swelling,discharge of necrotic tissue,delayed wound healing. Fifteen patients had active growth of tumor tissue, 1 patient had low-grade malignant giant cell tumor of tendon sheath. The recurrence rate was significantly higher in the group which preoperative X-ray was found to have bone destruction (P=0.003); patients receiving chemically inactivation had lower risk of recurrence after surgery than patients not receiving chemically inactivation(f^0.042). Conclusion:The recurrence rate of giant cell tumor of tendon sheath in upper limb was closely related to tumor growth site, bone destruction and chemical inactivation. Local excision of giant cell tumor of tendon sheath was the effective treatment. How to identify the patients at high risk of recurrence, how to reduce the recurrence rate and the functional restoration after wide resection are the priorities and difficulties of future researches.