骨盆肿瘤的切除与功能重建

RESECTION AND RECONSTRUCTION FOR TUMOR OF PELVIC RING

目的探讨骨盆不同部位肿瘤的最佳切除术式及其功能重建方法。方法1999年1月-2006年12月,对48例骨盆肿瘤患者进行骨盆肿瘤切除及重建手术。其中男32例,女16例;年龄14～72岁,平均45.1岁。良性肿瘤12例,恶性肿瘤36例。肿瘤累及Ⅰ区14例,Ⅱ区11例,Ⅲ区12例,Ⅳ区3例;肿瘤侵犯2个及以上区域8例。手术治疗术式选择:良性肿瘤予以刮除或边界切除,或加植骨;恶性肿瘤予以广泛切除或边界切除,植骨或不加植骨;对于累及髋臼部位肿瘤,采取肿瘤切除后行半盆置换、人工髋关节置换术,重建髋关节功能。结果12例骨盆良性肿瘤术后获随访12～72个月,均恢复较好的行走功能,1例半年后局部复发,放弃治疗。36例恶性肿瘤术后获随访6～72个月,其中生存6～12个月2例(5.6%),12～24个月2例(5.6%),24～36个月6例(16.7%),36～72个月14例(38.8%),72个月以上12例(33.3%)。21例行边界切除患者,未出现局部复发。28例(77.8%)恢复正常行走功能。21例行边界切除患者均恢复行走功能。术后发生并发症6例,其中静脉血栓2例,缺血缺氧性脑病1例,伤口延迟愈合2例,半盆置换术后髋关节脱位1例,经相应治疗已明显好转。结论根据肿瘤部位确定切除及重建手术,有利于取得较好的效果,提高患者生存质量。

Objective To discuss the resection of tumors of pelvic ring and its reconstruction of defects. Methods From January 1999 to December 2006, 48 patients with tumors in pelvic ring were treated and defects were reconstructed. There were 32 males and 16 females, aged 14-72 years（mean 45.1 years）, including 12 cases of benign tumor and 36 cases of malignant tumor. Fourteen cases had lesions in region Ⅰ , 11 cases in region Ⅱ , 12 cases in region Ⅲ, 3 cases in region Ⅳ and 8 cases had two or more regions. The selection of surgical method： benign tumor in wing of ilium or in sacro-iliac articulation was curettaged, malignant tumors were resected radically or boardly. Benign or malignant tumor in pubis, ischium or pubic symphysis was resected radically, defects were reconstructed with plastic plate or not. For tumor affecting aceta bulum , resection of tumor and replacement of the peri- pelvic prothetic or artificial hi p joint replacement were performed to recon- struct the function of hip joint. Results Twelve patients with benign tumors were followed up 12-72 months and could walk well, only 1 case relapsed locally. Thirty-six patients with malignant tumor were followed up 6 - 72 months, the survival time was 6-12 months in 2 cases （5.6%）, 12-24 months in 2 cases（5.6%）, 24-36 mongths in 6 cases （16.7%）, 36-72 months in 14 cases （38.8%）, and more than 72 months in 12 cases （33.3%）; 28 patients （77.8%） could walk normally, 6 （16.7%） could walk with the help of walking stick, 2（5.5%） needed wheel chair to move. Complications occurred in 6 cases（ including 2 venous thrombus, 1 anoxic encephalopathy, 2 wound delayed healing, and 1 dislocation after total hip joint replacement）; the patients＇ condition took a turn for the better. Conclusion Operation is a favorable way for the treatment of pelvic tumor. Selecting convenient operation methods to resect tumors or reconstruction defects according the position of the tumor will do good favor to good results, increase the survival time and improve quality of life.