经骶尾入路手术治疗43例骶前发育性囊肿的疗效分析

Transsacrococcygeal approach for the management of presacral developmental cysts: experience of 43 cases

目的总结骶前发育性囊肿的临床特点及探讨经骶尾入路手术的治疗效果。方法回顾性分析中山大学附属第六医院于2007年8月至2016年8月经骶尾入路手术治疗的43例骶前发育性囊肿患者的临床资料。结果本次研究中,男性4例,女性39例,临床症状不典型,在最终确诊前有16例患者曾被误诊。手术治疗均采用经骶尾入路,手术时间为(125±43)min,术中出血量为(157±56)ml,术中32例患者切除尾骨,4例患者切除部分骶骨及尾骨。术后伤口感染2例(4.6%)。术后病理结果:尾肠囊肿15例,表皮样囊肿9例,畸胎瘤14例,皮样囊肿4例,恶性畸胎癌1例。术后所有患者均获得随访,平均随访时间45(6~74)月,有1例患者复发,复发率2.3%。结论骶前发育性囊肿患者症状不典型,初诊时易被误诊,经骶尾入路手术可以治疗大多数骶前发育性囊肿,手术创伤小,出血少,明显降低了术后的并发症。

Objective To summarize the clinical features of presacral developmental cysts andinvestigate the therapeutic effect of transsacrococcygeal approach.Methods Clinical data of43patients withpresacral developmental cysts underwent transsacrococcygeal approach from August2007to August2016wasretrospectively analyzed.Results In this group,four male and39female patients were included.Theclinical presentations were nonspecific and sixteen patients were misdiagnosed before the correct diagnosiswas made.All patients were treated with tanssacrococcygeal approach.The operative duration was(125±43)min and the blood loss of each operative approach was(157±56)ml.Coccygectomy was performed in32patients and partial sacral resection was performed in four patients.The surgical incision infection occurredin two patients(4.6%).Postoperative pathological findings:fifteen patients had tailgut cysts,nine patientshad epidermoid cysts,fourteen patients had teratomas,four patients had dermoid cysts and one patient hadmalignant teratocarcinoma.The patients were followed up for6~74months(mean,45months)and the tumorrelapsed in one patient(2.3%).Conclusions The clinical presentations were nonspecific and patients withpresacral developmental cysts were easily misdiagnosed at first visit.Transsacrococcygeal approach can beused to manage majority of presacral developmental cysts with less blood loss and lower complication rate.