23例软组织肉瘤非计划切除的原因及对策分析

摘要

目的：分析导致软组织肉瘤非计划切除的原因并探讨避免软组织肉瘤非计划切除的策略。方法：自2009年10月至2012年12月新疆医科大学第一附属医院骨科中心骨病骨肿瘤科收治的105例软组织肉瘤患者资料，其中男性65例，女性40例，平均年龄52岁；接受计划性软组织肉瘤切除术患者82例（计划手术组），曾于外院接受非计划切除术的软组织肉瘤患者23例（非计划手术组）。计划手术组患者行广泛切除及根治切除术，非计划手术组患者行扩大切除术。统计分析两组患者一般情况、病灶位置及大小、手术边界、肿瘤复发转移情况，并比较两组患者生存期。结果：非计划手术组达到广泛切除边界的比例明显低于计划手术组（P<0.05）。非计划手术组患者3年生存率明显低于计划手术组（P=0.001）。非计划手术组平均随访18个月（3～36个月），12例死亡（52.2%），其中9例（39.1%）死于肿瘤转移，3例死于其他疾病；计划手术组平均随访23个月（5～36个月），15例（18.3%）死亡，其中12例（14.6%）死于肿瘤转移，3例死于其他疾病。结论：与计划手术相比，软组织肉瘤非计划切除常导致手术范围不足、肿瘤复发转移的风险，可能增高肿瘤所致的死亡率。临床医生应尽量避免非计划切除手术的发生。%Objective:To analyze the reasons for unplanned resection of soft tissue sarcomas and explore the treatment strategies for cancer surgery. Methods: The study included 105 patients with soft tissue sarcomas admitted to the First Affiliated Hospital of Xinjiang Medical University between October 2009 and December 2012. The average age of the patients was 52 years old. Among the patients, 65 were males and 40 were females. Up to 82 patients underwent planned resection (Group A) in our hospital, and 23 underwent unplanned resection (Group B) in other hospitals. Wide excision and radical resection were conducted in Group A, whereas extended resection was performed in Group B. General data, tumor location and size, resection margin, local recurrence and metastasis, and survival were statistically analyzed in the two groups. Results:The proportion attaining the margin of wide excision was obviously lower in Group A than in Group B (P<0.05). The 3-year survival rate was significantly higher in Group B than in Group A (P=0.001). Within an average follow-up of 18 months (3 months to 36 months) in Group B, 12 patients died, including 9 with tumor metastasis and 3 with other diseases. Within an average follow-up of 23 months (5 months to 36 months) in Group A, 15 patients died, including 12 with tumor metastasis and 3 with other diseases. Conclusion:Compared with planned surgical operation, unplanned resection of soft tissue sarcomas often leads to inadequate resection margin, which results in a high incidence of local recurrence and an increased mortality. Thus, clinicians should attempt to avoid unplanned resection of sarcomas.