目的 评估大腿软组织肉瘤患者行肌群切除术后肿瘤的局部复发率,肢体功能恢复以及术后并发症的发生情况.方法 回顾分析2009年1月至2016年8月间共23例于我院诊断为大腿软组织肉瘤,并行股四头肌肌群切除、内收肌群切除或者股后肌群切除的患者资料,其中男12例,女11例;年龄20～80岁,平均52岁.所有患者均进行大腿CT扫描和MR检查以明确肿瘤大小、侵犯范围及肿瘤所在肌群,同时行胸部CT扫描和双侧腹股沟淋巴结B超排除肿瘤转移.术前经CT引导下病灶穿刺活检,病理诊断明确为肉瘤.肿瘤的病理类型包括多形性未分化肉瘤7例;横纹肌肉瘤2例;原始神经外胚层瘤1例;滑膜肉瘤1例;平滑肌肉瘤3例;纤维肉瘤5例;脂肪肉瘤4例.股四头肌肌群切除患者6例;内收肌群切除患者8例;股后肌群切除患者9例.多形性未分化肉瘤、横纹肌肉瘤、原始神经外胚层瘤、滑膜肉瘤患者接受了术后辅助化疗,所有患者均未接受辅助放疗.结果 患者均顺利完成肌群切除术,手术时间1.5～3.5 h,平均2.2 h;术中出血量100～1 100 ml,平均313ml.所有患者均获得术后随访,随访时间17～108个月,平均41个月.1例多形性未分化肉瘤股后肌群切除患者术后镜下切缘阳性,术后6个月肿瘤局部复发行再次扩大切除,局部复发率4.3％.6例术后发生远处转移,其中5例为肺转移,另有一例为腹股沟淋巴结及肺转移;6例转移患者中5例死亡,1例带瘤生存.国际骨肿瘤协会(musculoskeletal tumor society,MSTS)功能评分14～30分,平均26.3分;9例股后肌群切除MSTS评分平均28分;8例内收肌肌群切除者平均29分;6例股四头肌肌群切除患者平均20.3分.术后并发症共5例,除1例肿瘤复发外,2例术后血肿形成,2例术后切缘皮肤坏死,均通过再次手术治愈;并发症发生率为21.7％.结论 大腿肌群切除术是治疗大腿软组织肉瘤的有效方法,可以减少术后复发的机会,除了股四头肌肌群切除术外,其它两个肌群的切除对下肢功能影响很小,同时大腿肌群切除术是一种相对安全的手术,术后并发症较少.“,”Objective To evaluate the local recurrence rate,limb function and complications of soft tissue sarcoma of thigh after muscle group resection.Methods Between January 2009 and August 2016,twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital,receiving thigh quadriceps muscle group resection,adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study.Patients who had received surgery of this lesion before,suffered from recurrent soft tissue tumor,had tumor involved multiple muscle groups which could not be resected completely,had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded.This retrospective study consisted of 12 male and 11 female.The age ranged from 20-80 with the average of 52.All the patients received CT and MRI of thigh to figure out the size of tumor,the invaded extension of the lesion and the specific muscle group involved.Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases.After all these examinations were done,needle biopsy with the guidance of CT scan was performed for the pathological diagnosis.The pathology included undifferentiated pleomorphic sarcoma (7 cases),rhabdomyosarcoma (2 cases),primitive neurotodermal tumor (1 case),synovial sarcoma (1 case),leiomyosarcoma (3 cases),fibrosarcoma (5 cases) and liposarcoma (4 cases).Sixpatients received quadriceps muscle group resection,eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection.Patients with undifferentiated pleomorphic sarcoma,leiomyosarcoma,primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy.None of patients received radiotherapy.After surgery,drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h.The affected thigh was bound up tightly.Intravenous antibiotics were used for 3 days to prevent from postoperative infections.Patients received quadriceps muscle group resection stayed in the bed for 4 weeks.After that they could walk with the protection of orthosis with unbending position.Other patients got out of bed after 2 weeks.All the complications after surgery were recorded.Reexaminations were arranged in 3,6,12 and 24 months after surgery separately.After that,reexamination was arranged every half a year.Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence.Lower limb function after surgery was evaluated by MSTS scores.Results All the surgeries of muscle group excision were successfully completed.The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h.The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL.The follow-up was a mean of 41 months (range,17-108 months).None was lost to follow-up.The local recurrence rate was 4.3％ (1/23).One patient with undifferentiated pleomorphic sarcoma had positive surgical margin,who received posterior compartment of the thigh resection.Local recurrence occurred 6 months after surgery.Then he received expanded resection.Six patients had distant metastases,five patients for lung metastases,one patient for lung and inguinal lymph node metastases.Of these,five patients had died and one lived with the metastasis.The median MSTS score was 26.3 points (range,14-30 points).Specifically,the median musculoskeletal tumor society (MSTS) score was 28 points (range,21-30 points) for 9 patients with posterior compartment of the thigh resection,twenty-nine points (range,27-30 points) for 8 patients with adductor muscle group resection,and 20.3 points (range,14-24 points) for 6 patients with quadriceps muscle group resection.Five patients had complications,including local recurrence (1 case),hematoma (2 cases) and cutaneous necrosis (2 cases),all of which were settled by reoperation.The rate of complication was 21.7％.Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh,which could reduce the risk of local recurrence,apart from quadriceps muscle group resection,the other two muscle group resections have limited impact on lower limb function,additionally,thigh muscle group resection is a safe procedure with few complications.