72例屏障切除术治疗四肢软组织肉瘤的切缘及疗效评估

屈国伦; 张如明; 陈勇; 曲兴龙; 张洪强; 王洪波; 王康伟; 彭帅

doi:10.19401/j.cnki.1007-3639.2024.03.007

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72例屏障切除术治疗四肢软组织肉瘤的切缘及疗效评估

论著 | 更新时间：2025-12-31

- 72例屏障切除术治疗四肢软组织肉瘤的切缘及疗效评估
- Surgical margin and efficacy evaluation of barrier resection for soft tissue sarcoma of extremities in 72 cases
- 中国癌症杂志 2024年34卷第3期页码：293-298
- 作者机构：
  
  1. 复旦大学附属肿瘤医院闵行分院肿瘤外科，上海 200240
  2. 复旦大学附属肿瘤医院骨软组织外科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "屈国伦（ORCID: 0009-0004-1967-9794），本科，主治医师。" ]
  陈勇（ORCID: 0000-0002-7188-4566），博士，主任医师、博士研究生导师。
- 基金信息：
  
  中国高校产学研创新基金-健合医疗创面修复专项(2021JH013)
- DOI：10.19401/j.cnki.1007-3639.2024.03.007
  中图分类号： R738.6
- 收稿：2023-08-15，
  
  修回：2023-12-25，
  
  纸质出版：2024-03-30
- 稿件说明：
移动端阅览
屈国伦, 张如明, 陈勇, 等. 72例屏障切除术治疗四肢软组织肉瘤的切缘及疗效评估[J]. 中国癌症杂志, 2024,34(3):293-298.

Guolun QU, Ruming ZHANG, Yong CHEN, et al. Surgical margin and efficacy evaluation of barrier resection for soft tissue sarcoma of extremities in 72 cases[J]. China Oncology, 2024, 34(3): 293-298.
屈国伦, 张如明, 陈勇, 等. 72例屏障切除术治疗四肢软组织肉瘤的切缘及疗效评估[J]. 中国癌症杂志, 2024,34(3):293-298. DOI： 10.19401/j.cnki.1007-3639.2024.03.007.

Guolun QU, Ruming ZHANG, Yong CHEN, et al. Surgical margin and efficacy evaluation of barrier resection for soft tissue sarcoma of extremities in 72 cases[J]. China Oncology, 2024, 34(3): 293-298. DOI： 10.19401/j.cnki.1007-3639.2024.03.007.

摘要

背景与目的：

四肢软组织肉瘤（soft tissue sarcoma，STS）是一类常见的恶性肿瘤，外科手术切除是其主要的治疗方法，而屏障概念的提出，让我们认识到自然屏障对STS的阻挡作用，寻找可以作为屏障作用的组织，进行以该组织屏障外围作为手术切缘的整块切除，从而保证很高的切缘阴性率并获得良好的局部控制效果。本研究旨在探讨屏障切除术治疗四肢STS的可行性、安全性及患者预后。

方法：

对2013年12月—2016年9月在复旦大学附属肿瘤医院闵行分院肿瘤外科行四肢STS屏障切除术且切缘进行取材的72例患者进行回顾性分析，72例患者手术均在术前行磁共振成像（magnetic resonance imaging，MRI）或计算机体层成像（computed tomography，CT）进行设计，于肿瘤所在解剖位置向外找到生理屏障或至少3 cm距离，并在此屏障外或3 cm距离以外进行整块切除。分析术后病理学切缘、国际骨与软组织肿瘤协会（musculoskeletal tumor society，MSTS）评分及术后并发症对患者的影响，评估患者1和3年的无局部区域复发生存（locoregional recurrence-free survival，LRFS）率和肉瘤特异性生存（sarcoma-specific survival，SSS）率，并对影响因素进行分析。本研究经复旦大学附属肿瘤医院伦理委员会审核通过（编号：1212117-12

1212117-12-1301）。

结果：

全部病例切缘均为阴性，1和3年的LRFS率分别为98.2%和93.8%，1和3年的SSS率分别为98.4%和94.2%。平均MSTS评分术前为28.3分，术后为25.5分。手术并发症1~2级20例，3级1例，无4~5级并发症。

结论：

基于临床、影像学和病理学三者相结合，包含肿瘤切除和功能重建的屏障切除术应用于STS的外科治疗，具有较好的可行性和安全性，切缘可靠，局部控制较满意。

Abstract

Background and purpose:

Limbs soft tissue sarcoma (STS) is a common malignant tumor

and surgical resection is the main treatment method for it. The concept of barrier made us realize the blocking effect of natural barrier on STS

and we aimed to search for tissues that can act as barrier

and to perform complete resection of surgical margins around the tissue barrier. This study aimed to investigate the feasibility

safety and prognosis of barrier resection in the treatment of limbs STS.

Methods:

From December 2013 to September 2016

data of 72 patients who underwent barrier resection of STS of extremities in department of oncosurgery

Minhang Branch

Fudan University Shanghai Cancer Center were retrospectively analyzed

and the resection margin was sampled. All 72 patients underwent preoperative magnetic resonance imaging (MRI) or computed tomography (CT) design

and the physiological barrier or at least 3 cm distance was found outward from the anatomical location of the tumor. And

en bloc

excision was performed outside this barrier or at a distance of 3 cm. The influence of postoperative pathological margin

musculoskeletal tumor society (MSTS) score and postoperative complications on the patients were analyzed. The 1- and 3-year locoregional recurrence-free survival (LRFS) rates and sarcoma-specific survival (SSS) rates were evaluated

and the influencing factors were analyzed. This study was approved by the Ethics Committee of Fudan University Shanghai Cancer Center (number: 1212117-12

1212117-12-1301).

Results:

All patients had negative margins. The 1- and 3-year LRFS rates were 98.2% and 93.3%

respectively. The 1- and 3-year SSS rates were 98.4% and 94.2%

respectively. The mean MSTS scores were 28.3 preoperatively and 25.5 postoperatively. Surgical complications were grade 1 to 2 in 20 cases and grade 3 in 1 case

and there were no grade 4 to 5 complications.

Conclusion:

Based on the combination of clinical

imaging and pathology data

barrier resection

including tumor resection and functional reconstruction

can be applied to the surgical treatment of STS

with good feasibility and safety

reliable margin and satisfactory local control.

关键词

Keywords

references

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