Bella Gino Paolo B, Manivel J Carlos, Thompson Roby C, Clohisy Denis R, Cheng Edward Y
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Clin Orthop Relat Res. 2007 Jun;459:186-91. doi: 10.1097/BLO.0b013e318063c61b.
The best treatment for intramuscular hemangiomas is unclear in part because the outcome is variable, with recurrence rates ranging from 18% to 61%. This variance is due to deficiencies in previous reports such as an inadequate population size, lack of life table analyses, lack of uniform pathologic criteria, and loose or absent definition of surgical margins. Our goal was to address these deficiencies and support or refute previous results. We identified 110 patients between 1981 and 2005. There were 48 males and 62 females with an average age of 22 years at the time of consult. Kaplan-Meier analysis showed 76% of patients managed initially without excision were surgery-free at 2 years and 66% at 5 years. For patients treated with surgery, 86% and 73% were recurrence free at 2 and 5 years, respectively. There were substantial differences in local recurrence when stratified by margin: 93% of patients were recurrence free at 5 years when the excision was marginal and wide, 65% when intralesional without any gross remaining tumor, and 33% when intralesional with gross remaining tumor. Surgical margins and tumor size were the only identified risk factors for recurrence.
肌内血管瘤的最佳治疗方法尚不清楚，部分原因是治疗结果存在差异，复发率在18%至61%之间。这种差异归因于既往报告存在的缺陷，如样本量不足、缺乏生命表分析、缺乏统一的病理标准以及手术切缘定义宽松或缺失。我们的目标是解决这些缺陷，并支持或反驳既往结果。我们纳入了1981年至2005年间的110例患者。其中男性48例，女性62例，初诊时平均年龄为22岁。Kaplan-Meier分析显示，最初未行切除治疗的患者中，76%在2年时无手术干预，66%在5年时无手术干预。接受手术治疗的患者，2年和5年时的无复发生存率分别为86%和73%。根据手术切缘分层时，局部复发存在显著差异：切除为边缘性和广泛性时，93%的患者在5年时无复发；瘤内切除且无肉眼残留肿瘤时，65%的患者在5年时无复发；瘤内切除且有肉眼残留肿瘤时，33%的患者在5年时无复发。手术切缘和肿瘤大小是唯一确定的复发危险因素。
