Daigeler Adrien, Lehnhardt Marcus, Khadra Ammar, Hauser Joerg, Steinstraesser Lars, Langer Stefan, Goertz Ole, Steinau Hans-Ulrich
Department of Plastic Surgery, Burn Center, Hand surgery, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
World J Surg Oncol. 2009 Feb 9;7:15. doi: 10.1186/1477-7819-7-15.
Proximal major limb amputations due to malignant tumors have become rare but are still a valuable treatment option in palliation and in some cases can even cure. The aim of this retrospective study was to analyse outcome in those patients, including the postoperative course, survival, pain, quality of life, and prosthesis usage.
Data of 45 consecutive patients was acquired from patient's charts and contact to patients, and general practitioners. Patients with interscapulothoracic amputation (n = 14), shoulder disarticulation (n = 13), hemipelvectomy (n = 3) or hip disarticulation (n = 15) were included.
The rate of proximal major limb amputations in patients treated for sarcoma was 2.3% (37 out of 1597). Survival for all patients was 42.9% after one year and 12.7% after five years. Survival was significantly better in patients with complete tumor resections. Postoperative chemotherapy and radiation did not prolong survival. Eighteen percent of the patients with malignant disease developed local recurrence. In 44%, postoperative complications were observed. Different modalities of postoperative pain management and the site of the amputation had no significant influence on long-term pain assessment and quality of life. Eighty-seven percent suffered from phantom pain, 15.6% considered their quality of life worse than before the operation. Thirty-two percent of the patients who received a prosthesis used it regularly.
Proximal major limb amputations severely interfere with patients' body function and are the last, albeit valuable, option within the treatment concept of extremity malignancies or severe infections. Besides short survival, high complication rates, and postoperative pain, patients' quality of life can be improved for the time they have remaining.
因恶性肿瘤导致的近端大肢体截肢已较为罕见，但仍是一种有价值的姑息治疗选择，在某些情况下甚至可治愈。本回顾性研究的目的是分析这些患者的治疗结果，包括术后病程、生存率、疼痛、生活质量和假肢使用情况。
从患者病历、与患者及全科医生的联系中获取45例连续患者的数据。纳入行肩胛胸壁截肢术（n = 14）、肩关节离断术（n = 13）、半骨盆切除术（n = 3）或髋关节离断术（n = 15）的患者。
肉瘤治疗患者中近端大肢体截肢率为2.3%（1597例中的37例）。所有患者1年生存率为42.9%，5年生存率为12.7%。肿瘤完全切除的患者生存率显著更高。术后化疗和放疗并未延长生存期。18%的恶性疾病患者出现局部复发。44%的患者观察到术后并发症。不同的术后疼痛管理方式和截肢部位对长期疼痛评估和生活质量无显著影响。87%的患者有幻肢痛，15.6%的患者认为其生活质量比手术前更差。接受假肢的患者中有32%经常使用。
近端大肢体截肢严重影响患者身体功能，是肢体恶性肿瘤或严重感染治疗理念中的最后一种选择，尽管有价值。除了生存期短、并发症发生率高和术后疼痛外，患者剩余时间的生活质量仍可得到改善。
