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目的 探讨肢体恶性肿瘤保肢手术的价值、适应证选择、手术操作原则、肿瘤局部复发与再手术、手术并发症、化疗的重要性、骨转移瘤的保肢手术、人工假体置入在保肢手术中的应用等问题。方法 对 2 74例肢体恶性肿瘤保肢手术的临床资料进行分析、讨论。结果 随访 6～ 15 6个月 ,平均随访 49 6个月 ,5年生存率为 31% ,肿瘤局部复发率为 5 % ,术后功能优良率为 6 3%。结论 保肢手术应作为四肢恶性肿瘤外科治疗的首选方法 ,术前后以大剂量MTX加四氢叶酸解救方案为主的系统化疗是提高 5年生存率 ,减少局部复发的关键因素之一 ,严格的选择保肢手术适应证 ,遵循边缘完整的切除肿瘤的原则是手术成功的前提条件 ,人工假体置入是保肢手术中肢体瘤段缺损修复、重建的较好方法 ,提高人工假体的设计与制造水平 ,提高手术技巧 ,将减少术后并发症的发生。
Objective To investigate the value of salvage limb salvage surgery, the choice of indications, the principle of operation, the local recurrence and reoperation of tumor, the complication of surgery, the importance of chemotherapy, limb salvage surgery of bone metastases, artificial prosthesis implantation Application of limb surgery and other issues. Methods The clinical data of limb salvage surgery in 2 74 cases of limb malignant tumor were analyzed and discussed. Results The patients were followed up for 6-15 months. The average follow-up was 496 months. The 5-year survival rate was 31%. The local recurrence rate was 5%. The excellent and good function rate was 6 3%. Conclusions Limb salvage surgery should be the first choice for the surgical treatment of malignant tumors of extremities. Systemic chemotherapy with high dose of MTX plus tetrahydrofolate rescue program before and after surgery is one of the key factors to increase 5-year survival rate and reduce local recurrence. The selection of indications for limb salvage surgery, follow the edge of the principle of complete tumor excision is the prerequisite for successful operation, artificial prosthesis implantation limb salvage limb salvage surgery is a better way to repair and reconstruction of artificial prosthesis Design and manufacturing standards, improve surgical skills, will reduce the incidence of postoperative complications.