四肢低度恶性软组织肿瘤的外科治疗

目的：总结四肢软组织低度恶性肿瘤的治疗经验及教训，以减少复发、提高生存质量。方法：本组共29（男11，女18）例，均为四肢低度恶性肿瘤：纤维肉瘤12例，腱鞘巨细胞瘤8例，高分化脂肪肉瘤6例，高分化平滑肌肉瘤3例。其中16例原发且与皮肤粘连紧密，13例外院或本院术后复发。肿瘤最大12cm×8cm×5cm，最小6cm×4cm×3cm。对其中13例复发及16例与皮肤粘连紧密者，行包括皮肤在内的肿瘤扩大切除、局部皮瓣或游离皮瓣修复，对位于腹股沟区或胭窝区与股、胭大血管及神经紧密粘连者，先从肿瘤远近端3—5cm以上血管、神经正常部分切除，再向病变区解剖、切除肿瘤，血管缺损行血管移植、神经缺损造成的功能障碍一期重建并早期行功能锻炼。结果：29例均获得随访，最长10年，最短6个月，目前全部患者均健在且无复发。行皮瓣修复者均成功，且皮瓣外观良好、厚薄适中，血管移植者，寒冷季节无肢端苍白及怕冷，行肌腱转移一期重建者功能恢复满意。结论：对四肢软组织低度恶性肿瘤，行扩大切除、皮瓣修复及一期重建是减少局部复发、提高生存质量的较好方法。

The surgical therapy of soft tissue neoplasms of low potential malignancy in limbs

Objective：To study the surgical therapy of soft tissue neoplasms of low potential malignancy in limbs in order to reduce the recurrence and increase the living quality. Methods： Twenty nine cases （11 males, 18 fe-males） with soft tissue neoplasms of low potential malignancy in limbs were involved： 12 fibrosarcomas, 8 giant cell tumors of tendon sheath, 6 well differentiated liposarcomas and 3 leiomyo-sarcomas. Among them, 16 cases were primary and adhere to the skin tightly while 13 cases recurred after operation. The maximum was 12cm x 8cm x 5cm, the minimum was 6cm × 4cm × 3cm. For 29 cases with soft tissue neoplasms of low potential malignancy in limbs, 13 recurrence and 16 adhesion of them were performed with wide resection and free or pedicled flap transfer. For the 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 above 3-5cm normal segment and then disconnect the lesion for excision of tumors completely. At the same time, vessel graft for vessel defect and functional reconstruc-tion for nerve defect and early exercise was necessary. Results： Using this method, we treated 29 patients. All cases had no recurrence and limbs disturbance in follow - up （ 10 years - 6 months）. All flaps survived and the patients were in good health and satisfied with their good shapes and proper thickness. For the patients with vessel graft, their acras were not afraid of coldness and had not pallor especially in cold season. The patients performed with one - stage tendon graft for reconstruction were satisfactory. Conclusion ： For the soft tissue neoplasms of low potential malignan-cy in limbs, performance with wide resection, flap repair and one - stage reconstruction is a better way of reducing lo-cal recurrence and increasing living quality.