摘要
目的分析韧带样纤维瘤的临床特点,并通过检测韧带样纤维瘤周边病理学改变以了解其生物学行为特点及复发的相关因素。方法收集2003年至2008年我科切除的56例韧带样纤维瘤患者的临床资料及标本,对其可能与术后复发相关的临床因素如:性别、年龄、肿瘤部位、体积、侵犯主要血管神经、侵犯骨、切缘质量、是否接受放疗及药物治疗等进行统计学分析,并对病灶周边组织进行组织病理学研究。结果本组患者均获得完整随访,随访时间33-108个月,总体复发率为39.3%,平均复发时间初治组为17.3个月(5-23个月),复发组为14.8个月(3-26个月)。患者的性别、年龄、肿瘤部位、体积、侵犯骨、是否接受放疗、药物治疗与肿瘤复发无统计学相关性,而侵犯主要血管神经、切缘质量与肿瘤复发有统计学相关性。切缘阴性、肿瘤未侵犯重要血管神经的患者术后复发率较低(P<0.05)。韧带样纤维瘤在病理学为良性,但可广泛浸润病变周边肌肉、脂肪、韧带、血管、神经、骨等组织,可突破骨皮质侵入髓腔内,但不能侵入血管及神经内部。结论韧带样纤维瘤术后复发率较高,侵犯主要血管神经、切缘质量是影响术后复发率的主要因素。病理学上,此病具有很强的局部侵袭能力,但无远处转移,术中达到满意的外科边界较为困难。所以当切缘阳性或单纯手术治疗效果不满意时可采用放疗、药物治疗等多种手段进行综合治疗,以降低局部复发率。
Objective To analyze the clinical features of desmoid tumors, and to detect the pathological changes around desmoid tumors to point out their biological behavior characteristics and the related factors affecting recurrence. Methods The clinical data and specimens of 56 patients who underwent desmoid tumor resection from 2003 to 2008 in our department were reviewed. Possible clinical factors related to postoperative recurrence including gender, age, location, size, invasion of major vessels and nerves or not, bone involvement, quality of surgical margins, adjuvant radiotherapy and pharmacotherapy or not and so on were analyzed statistically. The specimens round the lesions were studied histopathologically. Results All patients were followed up, and the follow-up time ranged from 33 to 108 months. The overall recurrence rate was 39.3%. The median time to relapse in primary group was 17.3 months （range; 5-23 months）, and that in recurrence group was 14.8 months （range; 3-26 months）. There was no statistical correlation between the gender, age, location, size, bone involvement, adjuvant radiotherapy or pharmacotherapy or not of the patients and the recurrence. However, there was a statistical correlation between the invasion to major vessels and nerves and quality of surgical margins and the recurrence. The postoperative recurrence rate of the patients with negative surgical margins and no tumor invasion of the major vessels and nerves was low （P〈0.05）. Desmoid tmnors were pathologically benign, which could extensively invade such tissues around the lesions as muscles, adipose tissue, ligaments, blood vessels, nerves, bones and so on. They were potential to destroy the cortical bone and invade the medullary cavity, but could not invade into the blood vessels or nerves. Conclusions Desmoid tumors have a high postoperative recurrence rate. The invasion of major vessels and nerves and quality of surgical margins are the main risk factors for postoperative recurrence rate. Pathologically, desmoid tumors are highly locally invasive with no distant metastasis, and it is hard to achieve satisfactory negative surgical margins during the operation. Therefore, integrated treatment including radiotherapy and pharmacotherapy can be an option with low local recurrence rate when the margin is positive or pure surgeries fail to control the disease.
出处
《中国骨与关节杂志》
CAS
2012年第6期557-564,共8页
Chinese Journal of Bone and Joint
