Higaki S, Tateishi A, Ohno T, Abe S, Ogawa K, Iijima T, Kojima T
Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Int Orthop. 1995;19(6):383-9. doi: 10.1007/BF00178355.
Extra-abdominal desmoid tumours (EADT) are benign lesions but difficult to cure because of their infiltrative nature and tendency to recur. Among many treatments recommended in the past, wide excision has been successful, even in difficult cases. We have analyzed retrospectively 41 cases of histologically confirmed EADTs. A total of 98 operations were performed on these patients: 29 wide excisions on 22 patients, 52 intra-lesional excisions with wide margins on 16 patients, and 17 incomplete excisions on 3 patients. One patient, with intra-pelvic lesions, died of a massive haemorrhage 3 days after surgery. Forty patients were followed from between 3 and 29 years. One, who had a multicentric EADT for 21 years, died from the disease. The significant factors concerning local recurrence after wide procedures were an unsatisfactory initial wide local excision, disease affecting 4 or more muscles and the invasive nature of the recurrences. We recommend wide local excision of these tumours in all anatomical areas that allow this procedure. When major nerves and vessels are involved, we recommend an intralesional excision with wide margins in order to preserve limb function. Radiation therapy should be confined to cases in which wide local procedures are not feasible. Overall, 37 of our patients (90%) were cured of the disease, 2 had their disease controlled, and 2 died.
腹外硬纤维瘤（EADT）是良性病变，但因其浸润性和复发倾向而难以治愈。在过去推荐的多种治疗方法中，广泛切除已取得成功，即使在困难病例中也是如此。我们回顾性分析了41例经组织学确诊的EADT病例。这些患者共接受了98次手术：22例患者进行了29次广泛切除，16例患者进行了52次带宽切缘的病损内切除，3例患者进行了17次不完全切除。1例盆腔内病损患者术后3天死于大出血。40例患者随访了3至29年。1例患有多中心EADT 21年的患者死于该病。广泛手术后局部复发的相关重要因素包括初始广泛局部切除不充分、累及4块或更多肌肉的疾病以及复发的侵袭性。我们建议在所有允许进行该手术的解剖区域对这些肿瘤进行广泛局部切除。当主要神经和血管受累时，为保留肢体功能，我们建议进行带宽切缘的病损内切除。放射治疗应仅限于无法进行广泛局部手术的病例。总体而言，我们的患者中有37例（90%）疾病治愈，2例疾病得到控制，2例死亡。
