164例骶骨原发肿瘤患者术后骶神经功能评价

Functional outcomes after sacral resection: a case series study of 164 cases with primary sacral tumor

目的探讨骶骨原发肿瘤患者接受手术治疗后的骶神经功能情况。方法骶骨原发肿瘤患者164例,术后通过电话随访患者皮肤感觉、行走功能、排尿费力、尿失禁、排尿感觉、排便费力、便失禁、排便感觉等情况,比较接受不同节段骶骨手术患者术后的骶神经功能,总结保留不同层面骶神经根对患者生活质量的影响。结果骶神经根离断水平越高对术后功能影响越明显,但不同层面骶神经对各方面功能的影响不尽相同。至少保留双侧S1神经根的患者术后出现严重皮肤感觉障碍、行走费力、步态异常以及需借助辅助装置转移等情况的概率明显低于仅保留双侧L5神经根的患者;至少保留单侧S3神经根患者术后出现排尿排便费力、尿和便失禁及排尿和排便感觉减退的概率及严重程度明显低于双侧S3神经根均被切除患者。而保留双侧S3神经根的患者发生尿失禁及漏尿的概率又明显低于仅保留一侧S3神经根患者。保留单侧全部骶神经根患者,其二便功能水平大致介于保留单侧S3及保留双侧S2患者之间。结论至少保留单侧S3神经根对保留患者术后的排尿和排便功能有着非常重要的作用。

Objective To investigate the postoperative neurological function of patients with primary sacral tumors. Methods Walking function, sensation, bowel and bladder continence, feeling of micturition and defecation were recorded for 164 consecutive primary sacral tumor patients after sacrectomy. Postoperative func-tional outcomes were compared in groups with different spared nerve levels. Results Patients with higher nerve root level sacrificed had worse function outcomes. Majority of motor and sensory function in lower limbs were preserved in patients with bilateral SI nerve roots spared. Compared with bilateral S3 nerve sacrificed, patients with unilateral S3 preserved had a lower incidence and degree of dysuria, bladder incontinence, abnormal blad-der sensation, constipation, fecal incontinence and abnormal rectal sensation. And the patients with bilateral S3 nerve preserved had a better outcome than those with unilateral S3 nerve preserved in the probability and degree of urine incontinence. The functional status of patients with unilaterally preserved S1-S4 falls in between the groups with preserved unilateral S3 and bilateral S2. Conclusion Preservation of at least one S3 nerve root in sacral resection saves bowel and bladder function in the majority of patients.