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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 characteristics of ligament-like fibroids and to investigate the biological behavior and related factors of recurrence by detecting the pathological changes of ligament-like fibroids. Methods The clinical data and specimens of 56 patients with ligamentous fibroma resected in our department from 2003 to 2008 were collected. The clinical factors such as gender, age, tumor location, volume, and invasion of major vascular nerves , Invasion of bone, quality of margins, whether or not to accept radiotherapy and drug treatment for statistical analysis, and histopathological study of the surrounding tissue lesions. Results The patients were followed up for 33-108 months with an overall recurrence rate of 39.3%. The mean recurrent time was 17.3 months (5-23 months) in the initial treatment group and 14.8 months (3 months) in the recurrence group -26 months). The gender, age, tumor site, volume, invasion of bone, whether or not to accept radiotherapy, drug treatment and tumor recurrence were not statistically significant, but violations of major vascular nerves, the quality of the margin and tumor recurrence were statistically significant. Patients with negative margins and no tumor invasion of major vascular nerves had a lower recurrence rate (P <0.05). Ligamentous fibroids in the pathology of benign, but extensive infiltration of lesions around the muscles, fat, ligaments, blood vessels, nerves, bones and other tissues, can break through the cortical invasion of medullary cavity, but can not invade the blood vessels and nerves inside. CONCLUSION: The recurrence rate of ligament-like fibroids is high, which invades the main vascular nerves. The quality of the margins is the main factor that affects the recurrence rate. Pathologically, the disease has a strong local invasion, but no distant metastasis, intraoperative satisfactory surgical boundaries more difficult. So when the positive margins or surgery alone is not satisfied with the results can be used radiotherapy, drug treatment and other means of comprehensive treatment to reduce the local recurrence rate.