计算机辅助下高位骶骨肿瘤的精确切除与缺损部位的重建

Computer-assisted precise resection of high-level sacral tumors and reconstruction of defects

目的探讨计算机辅助高位骶骨肿瘤精确切除和缺损部位重建的新方法，评价计算机辅助技术在高位骶骨肿瘤外科治疗的价值及意义。方法回顾2010年4月至2012年5月共收治4例骶骨肿瘤患者；其中男2例，女2例，年龄20～50岁。4例患者均采用薄层CT扫描获取病变的二维数据，重建三维解剖模型，运用计算机辅助设计（computeraideddesign，CAD）技术精确设计肿瘤切除范围、个性化辅助手术模板及个性化骨修复体，术中按照CAD方案精确切除肿瘤组织，根据CAD模型制作外形匹配的异体骨，重建骶骨，恢复骨盆的连续性。随访评价其功能。结果4例患者均实行了骶骨肿瘤的切除及缺损部位的重建手术，均顺利完成，手术时间为8～11h，平均9h。术中出血4100～6000ml，平均出血量为5300ml；输血量为3000～5100ml，平均输血量为3620ml。均未出现直肠-膀胱瘘等严重并发症。4例患者于2012年10月随访：2例术后3个月大小便恢复正常，无需搀扶，可正常行走，脚底稍麻木，无其它不适；1例术后3个月小便恢复正常，可感觉有便意，肛门括约肌功能稍差，需协助排便；1例术后2个月大小便不能控制。2例有正常性功能，2例未恢复性功能。结论将计算机辅助技术运用到高位骶骨肿瘤的手术治疗，可以正确设计肿瘤切除边界，准确避开周围复杂的血管和神经，重新恢复骨盆结构的完整性，降低手术难度，提高手术疗效。

Objective To investigate new approaches of computer-assisted precise resection of high-level sacral tumors and reconstruction of defects, and to assess the value and significace of computer-assisted technology in surgical treatment of high-level sacral tumors. Methods The data of 4 patients who were adopted from April 2010 to May 2012 were reviewed. There were 2 males and 2 females, whose age ranged from 20 to 50 years old. The 2-dimensional （ 2-d ） data of pathological changes for all the patients were acquired after thin layer CT scan, and 3-d anatomical model was reconstructed. Computer aided design （ CAD ） technology was used to accurately design tumor resection range, personalized auxiliary surgical template and personalized bone restoration. During the surgery, tumor tissues were precisely resected according to the CAD program. Shape matching allografts were made based on the CAD model. The sacrum was reconstructed, and the continuity of the pelvis was restored. The function was evaluated during the follow-up. Results Resection of sacral tumors and reconstruction of defects were performed on all the patients, which were successfully completed. The mean operation time was 9 hours （ range; 8-ll hours ）. The mean intraoperative bleeding was 5300ml （ range; 4100-6000 ml ）. The mean blood transfusion was 3620 ml （ range; 3000- 5100 ml ）. No serious complications such as rectum or bladder fistula occurred. 4 patients were followed up in October 2012. The function of bowel and bladder of 2 patients was normal 3 months after the surgery, who could walk normally without support but felt slightly numb in their soles. No other discomfort appeared. The function of bladder of 1 patientwas normal 3 months after the surgery, who had a bowel movement but needed help when defecating, due to the poor function of the anal sphincter. 1 patient had urine and stool incontinence 2 months after the surgery. 2 patients had normal sexual function, while the other 2 patients lost it. Conclusions When computer-assisted technology is applied in surgical treatment of high-level sacral tumors, the tumor resection boundary can be correctly designed, complicated blood vessels and nerves around can be accurately avoided, integrity of the pelvic structure can be restored, dififculty of the operation can be reduced and surgical effects can be improved.