盆环原发恶性肿瘤的切除与生物学重建

Surgical Treatment for Primary Pelvic-ring Tumors and Pelvic Reconstruction

目的:探讨骨盆环恶性肿瘤的切除、重建方式与并发症的处理。方法:手术治疗骨盆环原发恶性或低度恶性肿瘤5例,其中骶骨恶性畸胎瘤2例、脊索瘤1例,髂骨骨肉瘤1例、恶性骨软骨瘤1例。所有患者术前未行动脉栓塞、结扎髂内血管。髂骨翼肿瘤采用自体髂骨、髋臼肿瘤采用异体骨重建骨盆环、自体股骨头重建髋臼骨床+人工全髋关节置换术。结果:5例肿瘤均行根治性切除,3例骶骨肿瘤术中出血量150～800mL,术后出血300～1000mL,1例切口感染,1例术后出现失血性休克。髂骨翼肿瘤和髋臼周围肿瘤术中出血量分别为1000mL和4000mL,术后分别为800mL和1100mL。髂骨肿瘤切除与重建患者2月后恢复关节功能,髋臼肿瘤切除与重建患者6月后恢复功能,4例患者术后随访4～24个月,生存良好。结论:骨盆环恶性肿瘤的外科手术治疗关键是完整的手术切除,包膜外切除可以减少出血、预防复发,影响骨盆环稳定时应考虑重建,自体、异体骨移植能够恢复髋臼周围骨量、维持骨盆环生物学稳定。

Objective ：To discuss the techniques of tumor resection, pelvic reconstruction and postoperative management. Methods： Five patients with primary malignant and low potential malignant pelvic-ring tumors, which including two cases of sacral malignant teratoma, one of chordocarcinoma, one of pelvic osteosarcoma and another of chondrosarcoma, accepted surgical treatment, but did not undergo preoperative artery embolism and ligation. After tumor resection, 2 pelvic rings were reconstructed ; a patient with ala of ilium tumor was reconstructed with iliac autograft, another patient with peri-acetabular tumor with allograft, acetabular bed plus auto-femoral-head and hip arthroplasty. Results：The tumors in five patients got radical excision. The amount of hemorrhage was 150 to 800 mL during operation, postoperative 300 to 1 000 mL in three patients with sacral tumors. Infection of incisional wound occurred to one patient. Another patient present as hemorrhagic shock after operation. The patient with ala of ilium tumor lost blood of 1 000 mL during operation and of 800 mL after operation, accordingly, another patients with peri-acetabular tumor lost blood of 4 000 mL and 1 100 mL respectively. The patient with resection of ala of ilium tumor and pelvic reconstruction can walk without assistant of cane 2 months later. The patient with peri-acetabular tumor can walk 6 months later. 4 patients were followed up for 4 to 24 months and all lived healthily. Conclusions： Entirely en block resection is an important method for treating pelvic-ring malignant tumor; it can reduce hemorrhage and relapsing possibility. When stability of pelvic-ring was influenced, reconstruction of pelvic-ring was recommended. Allograft or autograft can restore the peri-acetabular bone mass and maintain biomechanical stability of the pelvic-ring.