骶骨肿瘤术后并发症分析及处理

Analysis and treatment of postoperative complications of sacral tumor after surgery

目的探讨骶骨肿瘤术后常见并发症及其处理方法。方法 2003年12月～2010年12月间手术治疗的38例骶骨肿瘤患者,其中男22例,女16例;平均年龄34.5岁(18～65岁)。统计患者术后出现的常见并发症,分析骶骨肿瘤并发症发生的原因及相应处理措施。结果 26例得到随访,最长5年,最短10个月,平均3.1年。术中无死亡病例。术后胃肠功能减弱31例;刀口不愈合2例,为放疗后皮肤改变,1例为S4肿瘤切除,换药半年未愈合,8个月后感染消耗死亡;1例拆线时皮肤裂开,残腔较小,给予医院自制生肌膏换药3个月后愈合。刀口积液并高烧3例,穿刺细菌培养证实为粪肠球菌,给予穿刺引流及万古霉素5～10 d后体温得到控制。术后出院时尿潴留2例,3个月时拔除尿管。术后随访期内固定松动3例,均为髂骨钉松动。结论骶骨肿瘤术中操作及术后积液容易刺激肠道,术后肠胀气概率较高,但一般可缓解;骶骨肿瘤局部软组织覆盖差,且接近会阴区,粪肠球菌感染率高,感染较难控制;放疗后皮肤愈合困难,选择手术应慎重;为避免术后尿潴留,应选择性切断神经根。

Objective To analyze the postoperative complications of sacral tumor and treatment strategy. Methods This retro- spective study included 38 cases of sacral tumors surgically treated from December 2003 to December 2010. The age of patients ranged from 18 to 65 years （mean 34.5 years）, including of 22 male and 16 female. Record the most common postoperative compli- cation of these, patients, causes and relative treatments were analyzed. Results After surgery., 26 cases were followed up for an average pericd of 3.1 years （ longest 5 years, shortest 10 months ）. None of＇ the patients died in surgery. The early complications S4 after surgery included gastrointestinal dysfunction in 31 cases. Nonunion of the incision occurred in 2 cases caused by radiation, one case with S4 tumor died of chronic infection after 8 monthes in spite of half year dressing, and the other was delayed union of the incision and the wound healed hy dressing with granulation promoting plaster after 3 monthes. Incisal effuscin with hyperpyrexia happened in 3 cases. Enterococal infection was confirmed by gemficulture. Body temperature restored normally after 5-10 d with a method of puncture drainage and the application of vaneomycin. Urine retention occurred in 2 eased after surgery and eatheter removed after 3 monthes. Internal fixation（ iliac screw） loosened in 3 cases during follow-up phase. Conclusion Because of stim- ulating bowel with effuscin and operation, gastrointestinal dysfunction in patients with sacral tumor rate is higher, but ＇alleviated eommonly. Sacral tumor patients with a higher incidence of enterococcal infection caused by differential tissue coverage and near perineum. The treatment of enterococcal infection is difficult. Be cautious about operating on patients after radiation. Selective nerve root should be preserved to avoid urine retention.