论文部分内容阅读
目的探讨臂丛区域肿瘤外科分区方法及相应手术路径,评估手术疗效及预后。方法回顾2008年1月至2014年12月收治的19例臂丛区域肿瘤患者。根据肿瘤相对臂丛主干解剖空间位置进行外科分区:臂丛上方、臂丛下方、臂丛内部、臂丛前方、臂丛后方,并采取相应的手术入路:锁骨上方入路、经典臂丛前路、改良三角肌胸大肌间隙入路、锁骨截骨入路、后方肩胛下入路,分析其临床结果。结果所有患者均获8~49个月随访,平均24.1个月。良性肿瘤10例(52.63%),交界性肿瘤3例(15.79%),恶性肿瘤6例(31.58%)。边缘切除13例,囊内切除6例,切缘阳性3例。2例术中并发神经损伤,随访末期1例症状改善。10例术前疼痛患者,术后8例疼痛消失,2例缓解。1例术前感觉异常患者术后症状缓解。6例术前活动障碍患者,术后4例恢复正常,2例得到改善。良性肿瘤随访过程均无复发。交界性复发2例。恶性肿瘤1例术后8个月因肺转移死亡,其余均健在未复发转移。结论根据肿瘤相对臂丛主干解剖空间位置,将臂丛区域肿瘤进行外科分区并选择相应的手术入路,此方法简单易交流,可获得良好的手术效果。
Objective To explore the method of surgical division of tumor in brachial plexus region and corresponding surgical pathology to evaluate the effect and prognosis of surgery. Methods From January 2008 to December 2014, 19 patients with brachial plexus tumors were retrospectively reviewed. According to the anatomical location of the tumor relative to the trunk anatomy of the surgical division: above the brachial plexus, below the brachial plexus, within the brachial plexus, anterior brachial plexus, and take the appropriate surgical approach: the supraclavicular approach, the classic brachial plexus Road, improved deltoid muscle pectoralis major approach, supraclavicular osteotomy approach, posterior subcapital approach, analyze its clinical results. Results All patients were followed up for 8 to 49 months with an average of 24.1 months. Ten cases (52.63%) of benign tumors, three cases of borderline tumors (15.79%) and six cases of malignant tumors (31.58%). Edge resection in 13 cases, cyst excision in 6 cases, 3 cases of positive margins. Two cases of intraoperative concurrent nerve injury, follow-up end of a case of symptoms improved. In 10 patients with preoperative pain, pain disappeared in 8 patients and was relieved in 2 patients. A case of preoperative sensory abnormalities in patients with postoperative symptoms. Of the 6 patients with preoperative dysfunction, 4 returned to normal and 2 improved. There was no recurrence of benign tumor follow-up. Borderline relapse in 2 cases. One case of malignant tumor died of pulmonary metastasis at 8 months after operation, and the rest were healthy without recurrence and metastasis. Conclusion According to the anatomical spatial location of the relative brachial plexus in the tumor, the tumor in the brachial plexus region is surgically partitioned and the corresponding surgical approach is selected. This method is easy to communicate and achieves good surgical results.