摘要
对107例滑膜肉瘤病例进行分析，发现其首次接诊而误诊90例，误诊率达84．1％，对误诊原因进行分析，其主要原因为：（1）由于本病较少见，临床医生对本病认识不够；（2）滑膜肉瘤的早期症状多不明显，病程长，故患者常对其严重性认识不足。（3）滑膜肉瘤的临床表现多样，易与其他病混淆。（4）本病的组织形态复杂，病理检查时取材不当，观察不细。另外提出早期诊断的依据有：（1）本病多发于11～40岁；（2）发生于关节周围（特别是四肢大关节）的肿块，具有开始增长缓慢，短期内还过发展，临床上表现无痛或轻度疼痛，肿块中等韧实，比较固定，境界清楚，具有压病。结合本组病例的病理分型与病程、预后的关系分析发现：（1）就诊前病程：分化型构在半年以上，而未分化型无一例超过半年，说明分化差者临床进展快；（2）未分化型恶性程度高，预后不良。（3）分化型中，纤维型和上皮样型随访存活率无区别，但上述两型与混合型有显著差别。关于滑膜肉瘤的治疗，作者提出对肿瘤广泛切除，区域肿大淋巴结清除，术前或术中动脉插管化疗，术中扎止血带，术后化疗及放疗的综合治疗方法，是提高治疗效果的关键。作者曾对8侧滑膜肉瘤采用综合治疗，其中7例术后已存活5年。
Collecting 107 cases of sgnoviosarcoma in our hospital from 1964 to 1995. The analysed 90 cases were ndsdiagnosed in the first treatment and the forsdiagnosis rate was 84.1%. The main reasons were. (1)Surgeons were not familiar with the disease because it was rarely seen ; (2)Synoviosarcoma had a long history and the symptoms of early stage are not obvious,so that the patients payed less attention ; (3)The clinical manifestation was various and easily confused with other diseases ; (4) The history were complex and pathological examination also contributed to misdiagnosis. The early diagnosis depended on: (1)Patients were between 11 to 40 years old, (2)The tumor located near the joint,growing slowly in early and fast in later with painless or slight pain. The mass was mild consistency and fixed with dear margin and tenderness. Combined analysis of pathology,course and prognosis revealed. (1)well-differentiated had long course while undifferentiated had short course ; (2)undifferentiated had high malignant degree and poor prognosis ; (3)In well-differentiated, fibrous type and epitheloid type had same survival rate, but both were significant different from the mixed type. Concern to the treatment, the authors suggested that combined using extension synovectomy, removng regional enlarged lymph nodes,chemotherapy via arterial catheter preoperation or in-operatien could reach better results. The auther had managed 8 patients with synthetic therapy. Among them 7 patients had survived more than 5 years.
出处
《陕西肿瘤医学》
1999年第3期144-147,共4页
ShanXi Oncology Medicine
关键词
滑膜肉瘤
误诊
综合治疗
诊断
Synoviosarcoma Misdiagnosis Synthetic therapy
