Pitcher M E, Fish S, Thomas J M
Department of Surgery, Royal Marsden Hospital, London, UK.
Br J Surg. 1994 Aug;81(8):1136-9. doi: 10.1002/bjs.1800810817.
A total of 485 patients with a proven or suspected diagnosis of soft tissue sarcoma were referred over a 3-year period. Of these, 61 were referred for opinion only and 424 for definitive treatment. Overall there were 223 patients with primary soft tissue sarcoma and 84 with recurrent sarcoma, 84 with benign soft tissue tumours and 22 with non-soft tissue sarcoma malignancy; 11 patients were referred with known metastatic disease. The commonest benign tumours mimicking soft tissue sarcoma were fibromatosis and benign intermuscular or intramuscular lipoma. The malignant tumours suspected clinically of being soft tissue sarcoma were bone tumours, lymphoma and metastatic carcinoma. Of the 172 patients with primary soft tissue sarcoma referred with a proven diagnosis this had been established by excision biopsy in 94 and open incision biopsy in 48. By contrast, of those undiagnosed at referral, 44 of 51 patients with soft tissue sarcoma had the diagnosis made by Tru-cut core biopsy. Amputation was performed in four of 165 patients with primary extremity soft tissue sarcoma and in five of 54 with recurrent extremity sarcoma, giving an overall amputation rate of 4 per cent. It is proposed that the amputation rate for extremity soft tissue sarcoma can be reduced by the use of reconstructive procedures, particularly myocutaneous flaps to the proximal limbs and limb girdles, and free vascularized flaps to sites distal to the midthigh and midarm.
在3年的时间里，共有485例经证实或疑似软组织肉瘤的患者前来就诊。其中，61例仅为咨询而来，424例为接受确定性治疗而来。总体而言，有223例原发性软组织肉瘤患者、84例复发性肉瘤患者、84例良性软组织肿瘤患者以及22例非软组织肉瘤恶性肿瘤患者；11例患者就诊时已确诊有转移病灶。最常被误诊为软组织肉瘤的良性肿瘤是纤维瘤病以及良性肌间或肌内脂肪瘤。临床上疑似为软组织肉瘤的恶性肿瘤包括骨肿瘤、淋巴瘤和转移性癌。在172例经证实诊断为原发性软组织肉瘤的就诊患者中，94例通过切除活检确诊，48例通过开放切口活检确诊。相比之下，在就诊时未确诊的患者中，51例软组织肉瘤患者中有44例通过粗针穿刺活检确诊。165例原发性肢体软组织肉瘤患者中有4例行截肢手术，54例复发性肢体肉瘤患者中有5例行截肢手术，总体截肢率为4%。有人提出，通过采用重建手术，特别是对近端肢体和肢体带使用肌皮瓣，以及对大腿中部和上臂中部远端部位使用游离血管化皮瓣，可以降低肢体软组织肉瘤的截肢率。
