经腹主动脉暂时阻断后行骶尾部巨大肿瘤切除(附5例报告)

The Resection of Huge Sacrococcygeal Tumors with Temporary Abdominal Aortic Block(A Report of 5 Cases)

目的：探讨骶尾部巨大肿瘤的改良手术方法。方法：对5例骶尾部巨大肿瘤行术前球囊导管腹主动脉暂时阻断,再经骶尾部入路作肿瘤切除术。病理证实脊索瘤2例,转移瘤2例,骨巨细胞瘤1例。术后辅以外放疗。结果：术中出血得到有效控制,出血仅50ml-600ml,肿瘤均得到肉眼全切,切口无感染,无手术死亡。随访1-2年,均未出现严重并发症。结论：骶尾部巨大肿瘤的手术治疗关键是控制术中出血,术前先行球囊导管腹主动脉阻断术再行骶尾部直视手术既安全又可靠,能显著减少术中出血,使术野清晰,肿瘤全切同时充分保留神经组织和重要结构,该方法值得推广。

Objective： To explore the improved surgical technique for huge sacrococcygeal tumors. Methods： Five cases of huge sacrococcygeal tumors were underwent surgical resection via sacrococcygeal approach and temporary abdominal aortic balloon block was performed before operation. The tumors were confirmed pathologically, including chordoma （n = 2） , metastatic tumor（ n = 2 ） and giant cell tumor（ n = 1 ）. Five cases were supplemented by postoperative radiation in vitro. Results： The blood loss could be effectively controlled in the course of operation, and the blood lose were 50ml - 600ml during the removal of tumor. All tumors were completely resected with the naked eye. There was no operative death. Aftel followed up for 1 - 2years, all eases had no wound infection and severe complications. Conclusion： Hemorrhage control is the key point in the resection of huge sacrococcygeal tumors. The surgical technique of temporary abdominal aortic balloon block before open surgery via sacrococcygeal approach is safe and reliable, which can significantly decrease the bleeding and make the surgical field clear. The goal of removing the tumors completely and retaining nerve tissue and important structure fully can be reached. This technique is worthy of promoting.