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目的 探讨传统引流联合负压封闭引流（VSD）技术在复发性软组织肉瘤创面治疗中的应用价值。方法 回顾性分析2015年9月至2017年6月期间在我科接受手术治疗的18例复发性软组织肉瘤患者，均采用肿瘤扩大切除或间室切除，术中均应用VSD技术覆盖手术创面，同时在创腔内常规置入多孔硅胶负压引流装置。术后根据创面长度，引流量的多少，调整负压值，一般在150mmHg～350mmHg，持续负压引流5～7天，随后停止负压封闭引流，传统负压引流装置待引流量<20mL/24h后拔除。随访观察手术时间，术中出血，术后引流量，创面愈合情况、术后并发症，肢体功能恢复情况以及患者肿瘤学预后等情况。结果 18例复发性软组织肿瘤均完整切除，切口长度13.8±5.0（5～25 ）cm，手术时间159.7±42（87～230）min，出血量568.9±195.4（300～950）mL，传统引流量436.1±189.9 ( 100～800 ) mL，VSD引流量 544.4±163.7 （260～800）mL，患者术后传统引流量与VSD引流量之间比较，差异无明显统计学意义（P>0.05）。全部患者获得随访，平均 28.6±9.3 （11～47 ）个月。所有患者术后3月MSTS 评分平均22.2±4.3（16～28）分，优良率83.3%。随访中13例患者无复发，3例患者局部肿瘤复发，并再次行手术切除，2例恶性肿瘤患者因远处转移死亡。结论 传统引流联合负压封闭引流技术可以起到充分引流，消灭死腔的作用，同时促进手术创面的愈合，缩短了治疗周期，取得了良好的治疗效果，但仍有待大样本及长期随访结果来进一步证实。
Objective To investigate the value of traditional drainage combined with negative pressure closed drainage (VSD) in the treatment of recurrent soft tissue sarcoma wounds. Methods 18 patients with recurrent soft tissue sarcoma undergoing surgery in our department from September 2015 to June 2017 were retrospectively analyzed. All the patients underwent surgical resection or resection of the tumor with VSD technique. In the cavity routinely placed porous silicone drainage device. Negative pressure was adjusted according to the length of the wound and the amount of drainage, usually 150mmHg ~ 350mmHg, continuous negative pressure drainage for 5 to 7 days, then closed negative pressure drainage, the traditional negative pressure drainage device to be drainage <20mL / Remove after 24 hours. Follow-up observation of operative time, intraoperative bleeding, postoperative drainage, wound healing, postoperative complications, limb function recovery and prognosis of patients with oncology. Results 18 cases of recurrent soft tissue tumors were completely resected. The length of incision was 13.8 ± 5.0 (5 ~ 25) cm, the operation time was 159.7 ± 42 (87 ~ 230) min and the amount of bleeding was 568.9 ± 195.4 (300 ~ 950) mL. 436.1 ± 189.9 (100 ~ 800) mL and VSD drainage 544.4 ± 163.7 (260 ~ 800) mL, respectively. There was no significant difference between the traditional drainage and the VSD drainage (P> 0.05). All patients were followed up for an average of 28.6 ± 9.3 (11 ~ 47) months. The MSTS score of all patients was 22.2 ± 4.3 (16 ~ 28) on average after 3 months. The excellent and good rate was 83.3%. Follow-up in 13 patients without recurrence, 3 patients with local tumor recurrence, and again underwent surgical resection, 2 patients died of malignant tumor due to distant metastasis. Conclusion The traditional drainage combined with negative pressure closed drainage technology can play a full drainage, the role of dead space elimination, while promoting the healing of surgical wounds, shorten the treatment cycle, and achieved good therapeutic effect, but still to be large samples and long-term follow-up results Further confirmed.