骶骨骨巨细胞瘤外科治疗单中心回顾性分析

A retrospective analysis of surgical treatment for giant cell tumor in sacrum:a single-center study

目的探讨骶骨骨巨细胞瘤的外科治疗方法、临床效果及并发症。方法回顾性分析了在我中心于1990～2017年接受治疗的27例骶骨骨巨细胞瘤患者的病历资料,男10例,女17例,平均34 (19～50)岁。其中2例A型(累及S3以下)接受病灶边缘性切除;8例B型(累及S2及以下)、12例C型(累及S1及以下)、5例D型(累及骶髂关节)接受瘤内刮除术。术后随访18～132个月,平均58个月。其中5例失访,入组22例。结果术后复发6例(27%),均为接受病灶刮除病例。2例行再次刮除后未复发,4例行保守治疗(连续栓塞,迪诺单抗)后1例肺转移,其余病变未有进展,目前均带瘤存活。刮除术后患者均有不同程度的鞍区麻木及一过性二便功能障碍。5例术后出现伤口深部积液,1例出现肠瘘,1例出现内固定断裂。结论对于S3以下骶骨骨巨细胞瘤整块切除术可获得较好效果;对于S3以上病变瘤内刮除可以保护患者的鞍区感觉和二便功能。

Objective To investigate the surgical treatment for giant cell tumors in sacrum and to evaluate the operation method,local recurrence rate and complications.Methods A retrospective study of 27 patients diagnosed with giant cell tumors in sacrum had been conducted from 1990 to 2017.There were 10 males and 17 females with an average age of 34 years(range:19-50 years).En bloc resection was carried out in 2 patients with tumors below S3 level(A).Intralesional resection was carried out in 8 patients with tumors S2 and below(B),12 patients with tumors S1 and below(C)and 3 patients with tumors S1 and sacroiliac involvement(D).The average follow-up period was 58 months(range:18-132 months).Five cases were lost to follow-up.Twenty-two cases were adopted to this study.Results There were 6 local recurrences(27%)who received initial operation.Two patients received a second surgery with no local recurrence.Four cases received conservative treatment,such as embolization and Dino single resistance.One case appeared lung metastasis.All cases had no significant neurological loss after treatment.Neurological symptoms were common and brief.Symptoms included brief bowel or bladder incontinence and perineal hypoesthesia.Five patients had deep wound effusion,1 case had intestinal fistula,and 1 case had internal fixation breakage.Conclusions En bloc resection is a better surgical treatment for patients with tumors below S3 level(A).The tumors can be locally controlled and neurological function can be preserved after isintralesional resection for patients with tumors above S3 level(B/C/D).