原发性骶骨肿瘤的手术治疗

Surgical treatment of primary sacrum tumor

目的 总结原发性骶骨肿瘤手术治疗的体会。方法 回顾性分析1993年9月～2004年12月手术治疗骶骨肿瘤患者21例。肿瘤位于S3以上者9例；S3以下者12例。本组行全骶骨切除和次全骶骨切除9例，骶骨部分切除12例。并就其外科治疗的手术方法选择、并发症防治以及决定手术成败关键问题的处理进行探讨。结果 全部手术无一例死于术中。术后近期并发症2例为切口皮缘坏死；3例皮下血肿；2例脑脊液漏，2例局部浅表感染。随访18例，随访时间最长9年，最短13个月，平均2．6年，1例死于慢性感染，3例死于肿瘤复发和转移，14例能从事一般工作。结论 术前详细地了解肿瘤的性质、侵犯的部位和范围对手术方案的设计具有重要意义；而减少术中出血、保留马尾神经功能以及重建高位骶骨肿瘤术后骨盆负重功能则是决定手术成败的关键。

Objective To summarize the experience about the sugical treatment of primary sacrum tumor. Methods Twenty-one cases of primary sacrum tumor treated surgically were retrospectively analyzed from September 1993 to December 2004, including 9 cases with sacrum tumor located above S3and 12 below S3. Nine cases were given totalosacrectomy or subsacrectomy, 12 cases partial-sacrectomy. The explore was made about the choice of operative method, the prevention and cure of complication, and the management of the key problem which decided the surgical result. Results None of the patients died at surgery. The postoperative early complications included necrosis of the incision margin in 2 cases, subcutaneous hematomas in 3 cases, leakage of cerebrospinal fluid in 2 cases and local superficial infection in 2 cases. Eighteen cases were followed up for an average period of 2.6 years （ longest 9 years, shortest 13 months）. One case died of chronic infection, 3 cases died of recurrence and metastasis, and 14 cases restored their common work. Conclusion In order to design operative scheme, it is very important to study tumor character, position and scope invaded by tumor in detail before operation. Meanwhile, it is operative key to lessen operative hemorrhage, reserve the function of cauda equina and rebuild weight-loading function of the pelvis after superior sacrum tumor is removed.