改良Stoppa入路在坐骨大孔肿瘤手术中的应用

The modified Stoppa approach for resection of retroperitoneal pelvic tumors involving foramen sciaticum majus

目的 探讨改良Stoppa入路在坐骨大孔肿瘤手术中的应用。方法 应用改良Stoppa入路对6例累及坐骨大孔的骨盆肿瘤的患者进行手术,作耻骨联合上缘2 cm处横形切口,向两侧拉开腹直肌或切断患侧腹直肌以显露耻骨联合和耻骨上支。结扎切断腹壁下动脉和闭孔动脉之间的吻合支。切开髂耻筋膜,将下腹壁肌、髂外血管、股神经和髂腰肌拉向前外侧,沿腹膜外间隙将盆腔脏器拉向内侧。先沿髂外血管逆行向上分离并结扎髂内动脉。在骶髂关节前方辨认分离腰骶干并行骨膜下剥离保护,沿神经行程分离骶神经根。经改良Stoppa入路可以有效显露真骨盆,前至闭孔,内侧接近骶骨中线,外侧可达坐骨大孔,后侧达骶骨前方,上缘达L5/S1椎间隙水平。肿瘤完整切除并仔细止血,腹膜外放置引流管后逐层缝合切口。结果 本组6例坐骨大孔肿瘤均完整切除。改良Stoppa入路切口长度8~12（9.2±1.6）cm,手术时间90~150（112±23）min,出血250~650（320±160）m L,术中对盆腔腹膜后肿瘤显露良好,无神经血管损伤、盆腔脏器损伤、深静脉血栓等并发症。全部病例获得6~30个月随访,截至末次随访时均无局部复发。结论 改良Stoppa手术入路兼具切口较小、手术视野清晰、易于操作、并发症少的特点,是在累及坐骨大孔的盆腔腹膜后手术中的合适选择。

Objective To investigate the application of the modified Stoppa approach in surgical resection of retroperitoneal pelvic tumors involving foramen sciaticum majus. Methods The clinical data of 6 cases of retroperitoneal pelvic tumors involving foramen sciaticum majus were retrospectively analyzed. The modified Stoppa approach was applied for the resection of the tumors. Results All the patients received completely resections of the retroperitoneal pelvic tumors were followed up of 11.25 months （6 -30 months）, with no recurrence. The length of the incision was 8 - 12 （9.2 ± 1.6）cm, operative time was 90 - 150（ 112 ±23）min, and blood loss was 250 -650（320 ±160） mL. Splendid exposure of retroperitoneal pelvic tumor was observed during operation. All patients recovered well without neurovascular injury, pelvic organ injury, wound infection or deep venous thrombosis. Conclusion The modified Stoppa approach provides small incision and excellent visualization for resection of retroperitoneal pelvic tumors, thus permits good intra - and postoperative results. We suggest this approach as a feasible pathway for the resection of retroperitoneal pelvic tumors involving foramen sciaticum majus.