骶骨肿瘤的综合治疗

Composite treatment for the sacral tumors

目的 介绍骶骨肿瘤的外科手术治疗,重点阐述高位骶骨肿瘤的治疗手段。方法 自1992年1月～2000年3月共治疗骶骨肿瘤64例,骨巨细胞瘤、脊索瘤、神经源性肿瘤及转移癌为主要的诊断。对于低于S2的病变可安全地施行骰骨部分切除术;而对高于S2甚至高达腰椎的骶骨病变则采取前后联合入路、直视下刮除及局部置管持续化疗的方法,滴注时间可持续1周。研究证明高浓度的铂类药物对马尾神经无可见的不良影响。结果4例良性肿瘤者单纯行摘除术均治愈。9例部分切除者中仅1例复发;51例高位骰骨肿瘤的局部控制率为76.5％,无严重而无法控制的并发症。结论 前后联合入路、直视下刮除加局部高浓度化疗是高位骶骨肿瘤的有效治疗手段,多数患者可避兔创伤很大的全骶骨切除术。

Objective To assess the efficacy of partial sacrum resection for the tumor located below S2 level and the regional chemotherapy after curettage through the anterior-posterior combined approach for the tumor above S2, S1 levels. Methods For the lesions below the S2, anterior-posterior combined approach was used for partial sacrectomy. For the neoplasms beyond S2 or S1, anterior-posterior combined approach was used for curettage under direct vision, followed by continuous perfusion of the remaining tumor cavity for one week with high concentration anticancer drugs(cisplatin 400 -600 mg/L or carbonoplatin 2 g/L) to eliminate the macroscopic tumor cells. Results One of 9 patients undergone partial sacrectomy had recurrence. Of the 51 patients with high level tumor treated by curettage followed regional chemotherapy, 11 died and one had recurrence. The local control rate was 76. 5%. There was no severe complications. Conclusion The methods introduced in this paper are safe and effective to deal with sacral neoplasms, especially for the high level tumors. In most of the cases, total sacrectomy can be avoided.