经前后联合入路切除骶骨巨大肿瘤

Surgical treatment of tumors involved sacrum

[目的]探讨骶骨巨大肿瘤的外科治疗。[方法]回顾分析2002年9月～2006年2月经前、后联合入路切除骶骨巨大肿瘤18例。男11例，女7例；年龄31～65岁，平均43岁。恶性肿瘤14例，包括脊索瘤8例，骨巨细胞瘤5例，软骨肉瘤1例，根据Enneking分期均属IA—IB；良性肿瘤4例，包括神经纤维瘤3例，动脉瘤样骨囊肿1例。[结果]18例患者无术中死亡，术中无严重并发症，肿瘤均获安全彻底切除，术中出血1000—5000ml。4例术后5—7d出现皮缘坏死，经换药后2例愈合，另2例经后期臀大肌瓣推移覆盖后愈合，其余切口均一期愈合。术后随访6个月-3．5年，平均2．6年。至目前仅2例脊索瘤术后2年复发。[结论]骶骨巨大肿瘤的骨破坏往往较广泛，盆腔残留间隙狭小，盆腔脏器多有黏连或侵犯，骶骨肿瘤切除术通常有显露困难、出血多、易致大小便功能或性功能障碍和肿瘤不易彻底切除的特点。经前、后入路切除骶骨巨大肿瘤具有骶前显露充分、利于肿瘤完整分离、便于处理血管、利于保护下腹下神经丛等优点。保留单侧S1、S2、S3或双侧S1、S2单侧S3可保全大部分括约肌功能，同时保存大部分下腹下神经丛，可避免性功能障碍。

[ Objective] To discuss the surgical treatment of huge tumor invovled sacrum. [ Method] A review of records in 18 patients with tumors invovled sacrum was made. Age at surgery averaged 43 years （range： 31 -65 ）, eleven patients were male, seven patients were female. In this series, malignant tumor was in 14 cases, according to Enneking classification, these cases were classified to Ⅰ A - Ⅰ B subtypies, which concluded chordoma （8 cases）, giant cell tumor （5 cases） and osteo- chondroma （1 case）. Benign tumor was in 4 cases with neurogenic tumor （3 cases） and aneurysmal bone cyst （ 1 cases）. [ Result] Over all, no patients were dead in the operation, no other major complications were occurred, the blood loss during surgery was 1 000 ml to 5 000 ml. All incisional wound were primary healing except 4 cases, two of them gained secondary closure after gluteus maximus pushing flap. Eighteen patients gained follow-up visiting, the average time of follow-up was 30 months, only 2 cases were tumor recurrence. [ Conclusion ] Huge tumors invovled sacrum present a great challenge, because of many organs surrounding sacrum invovled and complexity in anatomic region, sacrectomy of sacral tumor always complic generous blood loss, disorder of urination and defecation, disorder of sexual function et al. Abdominosacral approach can lead to a safer and relative radical local control of tumor, it is benefit to protect blood vessel and nerves.