腹腔镜下骶前肿瘤切除术6例临床分析

Laparoscopic resection of presacral tumors: clinical analysis of 6 cases

目的：探讨腹腔镜下切除原发性骶前肿瘤的可行性、手术方法及安全性。方法：回顾分析6例原发性骶前肿瘤患者的临床资料,术前经直肠指诊、B超、CT和/或MRI做出诊断,均采用完全腹腔镜手术切除肿瘤。患者21~63岁,平均（40.8±13.5）岁;肿瘤直径平均（6.7±2.1）cm。结果：肿瘤均被顺利完整切除,术中未出现不可控制的出血,出血量200~1 100 ml,平均（350.2±118.3）ml;6例患者术后24~72 h肠道功能恢复并进食,未出现腹部并发症。随访3~24个月,平均（11.2±7.2）个月,随访期间患者均未出现肿瘤复发,排尿及性功能基本正常。术后标本病理类型：皮样囊肿2例,良性畸胎瘤1例,间质瘤1例（高风险）,脂肪瘤1例,神经纤维瘤1例。结论：腹腔镜下切除骶前肿瘤是安全、可行的,与既往文献报道的开腹手术相比,具有出血少、创伤小、术后康复快、住院时间短等优点,是技术条件成熟的医院可选择的手术方式。

Objective： To investigate the feasibility,operation methods and safety of laparoscopic resection of primary presacral tumors. Methods： The clinical data of 6 patients with primary presacral tumors who underwent totally laparoscopic operation were analyzed retrospectively. The diagnosis was made by using the digital rectal examination,B-ultrasound,CT and / or MRI. The age of the patients was from 21 to 63 years old,（ 40. 8 ± 13. 5） years old on average. The average diameter of the tumor was（ 6. 7 ± 2. 1） cm. Results： The tumors were completely resected. There was no uncontrollable bleeding in operation,and the bleeding volume was from 200 to1 100 ml with the average of（ 350. 2 ± 118. 3） ml. During 24 to 72 h after operation,6 patients recovered the function of gastrointestinal tract and were fed,and no abdominal complications occurred. All the patients were followed up for 3 to 24 months,（ 11. 2 ± 7. 2）months on average,and no recurrence of tumor was found during the follow-up period. The urination and sexual function of the patients were normal. Pathological types included dermoid cyst（ 2 cases）,benign teratoma（ 1 case）,stromal tumor with high risk（ 1 case）,lipoma（ 1 case） and nerve fiber tumor（ 1 case）. Conclusions： Laparoscopic resection of presacral tumors is safe and feasible. Compared with reported open surgery,laparoscopic resection of presacral tumors has the advantages of less bleeding,fewer trauma,quicker recovery,shorter hospital stay and so on,it is the choice of operation for hospital with mature technology.