血行再建を併用した患肢温存手術の治療成績

Vascular Reconstruction in Limb Salvage Surgery for Bone and Soft Tissue Sarcomas

　抄録：悪性骨軟部腫瘍に対する患肢温存手術に際して主幹血管を合併切除し血行再建を行った症例の治療成績について検討した．症例は男性8例，女性5例，計13例，年齢は18～68歳であった．部位は下肢12例，上肢1例であった．血行再建の内訳は動静脈7例，動脈5例，静脈1例であり再建材料は自家静脈11例，人工血管2例であった．術後経過観察期間は平均43カ月であった．遅発性動脈閉塞にて大腿切断に至った1例を除く12例，92％で患肢温存が可能であった．また1例に局所再発を生じた他は良好な局所根治性が得られた．人工血管を使用した2例に感染を合併したが追加手術にて治癒した．初診時より転移を認めた5例を含む全症例の5年生存率は37.6％であり，転移のない8例では52.5％であった．Musculoskeletal Tumor Societyによる患肢機能評価の％ratingは平均82％であった．腫瘍による主幹血管浸潤は患肢温存手術が可能であり切断の必要はない．

　The purpose of this study was to evaluate the outcome of 13 patients who undergone combined resection of major vessels for the treatment of bone and soft tissue sarcomas. The tumors of all of the patients except one were located in the thigh. The average follow-up period was 43months. Vascular reconstruction included both artery and vein in 7 patients, artery only in 5, and vein only in one. The material used for reconstruction was a contralateral great saphenous vein in 11 patients and a synthetic graft in two. The reconstruction was successful in all patients except one patient with chronic occlusion that ultimately necessitated mid-thigh amputation. Local recurrence and with systemic relapse occurred in one patient. The overall 5-year survival rate of all patients and the 8 patients without distant metastasis at presentation was 37.6％and 52.5％, respectively. The average functional score according to the Musculoskeletal Tumor Society system was 82％. Thus, vascular reconstruction combined with limb salvage can achieve satisfactory results in vassel-threatening sarcomas.