经腹、骶联合入路切除骶骨巨大肿瘤

Surgical treament of macro-tumors involved sacrum

目的:探讨骶骨巨大肿瘤的外科治疗。方法:回顾分析2003年9月至2006年1月15例经腹、骶联合入路切除骶骨巨大肿瘤患者的临床资料。男9例,女6例,年龄31～65岁,平均43岁。恶性肿瘤12例,包括脊索瘤7例,骨巨细胞瘤4例,软骨肉瘤1例,根据Enneking分期均属ⅠA～ⅠB;良性肿瘤3例,包括神经纤维瘤2例,动脉瘤样骨囊肿1例。结果:15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。3例术后5～7d出现皮缘坏死,经换药后1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2个月～2.5年,平均1.6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,盆腔脏器多有粘连或侵犯,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。经腹、骶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。

To explore the surgical treatment of macro-tumor invovled sacrum. Methods Fifteen patients with tumors invovled sacrum were reviewed, aged from 31 to 65 years old （averaged 43 years old） at surgery, nine patients were male and six were female. According to Enneking classification, malignant tumor was 12 cases, belong to I A ～ I B subtypies, which concluded chordoma（7 cases）, giant cell tumor（4 cases） and osteochondroma（ 1 case）. Benign tumor was 3 cases, concluding neurogenic tumor（2 cases） and aneurysmal bone cyst（ 1 case）. Results Over all, no patients were dead in the operation, no other major complications occurred, the estimated blood loss during surgery was 1 000 to 5 000 mL. All incisional wound were primary healing except 3 cases, of which two gained secondary closure after gluteus maximus pushing flap. Fifteen patients gained follow-up visits, the average time follow-up was 19.2 months, only 2 cases appeared tumor recurrence. Conclusions The surgery of macro-tumors invovled sacrum present a great chanllenge because many organs invovled surrounding sacrum and complexity in anatomic region, sacrectomy of sacral tumor always lead to generous blood loss, disorder of urination and defecation, disorder of sexual function and so on. It is suggested that abdominosacral approach is a good alternative therapy of macro-tumors involved sacrum because of sufficient reveal before sacrum, complete dissociation of tumour and protection of blood vessel and inferior hypogastric plexus.