Yang Fa-jun, Ding Yi, Niu Xiao-hui, Deng Zhi-ping
Department of Orthopaedic Oncology, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Wai Ke Za Zhi. 2011 Nov;49(11):986-90.
To detect the character of surgical treatment of massive soft tissue sarcoma in the shoulder girdle and analyze the impact factor to the result.
Seven patients with massive soft tissue sarcoma in the shoulder girdle were treated in our department between 2005 and 2009. There were 4 males and 3 females. All the patients were referred to our hospital after local recurrence post-operatively. The mean age was 43.8 years old (range 14 - 75). The maximum diameter of the tumor varied from 10 to 16 centimeters. All the patients were performed surgery, wide margin in 4 cases and marginal margin in 3 cases. Five were performed tumor resection and reconstruction with latissimus dorsi muscle flap transfer and skin graft. One was reconstructed with advanced skin flap and skin graft. The other one was treated with skin graft. The diagnosis included 3 malignant fibrous histiocytomas, 1 low grade myxoid fibrosarcoma, 1 Primitive neuroectodermal tumor, 1 rhabdomyosarcoma, 1 dermatofibrosarcomas protuberans. The MSTS score system was used to evaluate the shoulder function.
Seven patients were followed up with long time. The mean follow up was 29 months (range 10 to 46 months). Two patients suffered local recurrence and one died of pulmonary metastasis 6 months after the second surgery for local recurrence. One patient suffered pulmonary metastasis. The last four patients were disease-free at the end of follow-up. The function of shoulder girdle was satisfactory. The mean MSTS score was 28.
Soft tissue sarcomas in the shoulder girdle are easy to be misdiagnosed and mistreated. Wide surgical margin was the key impact factor to the local recurrence of soft tissue sarcoma in the shoulder girdle. The surgical margin and invasion of the tumor are the key factor to the prognosis. The soft tissue defect after surgery is often reconstructed by muscle flap transfer or skin flap transfer. The latissimus dorsi muscle flap transfer is often used.
探讨肩胛带区巨大软组织肉瘤的外科治疗特点，并分析影响治疗效果的因素。
2005年至2009年我科收治7例肩胛带区巨大软组织肉瘤患者，男4例，女3例。均为术后局部复发后转入我院。平均年龄43.8岁（14～75岁）。肿瘤最大直径10～16厘米。均行手术治疗，4例行广泛切除，3例行边缘切除。5例行肿瘤切除并背阔肌肌瓣转移加植皮重建，1例行推进皮瓣加植皮重建，1例行单纯植皮。病理诊断：恶性纤维组织细胞瘤3例，低度黏液性纤维肉瘤1例，原始神经外胚层肿瘤1例，横纹肌肉瘤1例，隆突性皮肤纤维肉瘤1例。采用MSTS评分系统评价肩关节功能。
7例均获长期随访，平均随访29个月（10～46个月）。2例局部复发，1例在第二次局部复发手术后6个月死于肺转移，1例发生肺转移。最后4例随访结束时无瘤生存，肩胛带功能满意，MSTS平均评分为28分。
肩胛带区软组织肉瘤易误诊误治。广泛的手术切缘是肩胛带区软组织肉瘤局部复发的关键影响因素。手术切缘及肿瘤侵犯情况是影响预后的关键因素。术后软组织缺损常采用肌瓣或皮瓣转移修复，常用背阔肌肌瓣转移。
