O-Arm导航引导下保留骶1神经根的高位骶骨肿瘤切除术

Resection of high sacral tumors with preservation of sacral1 nerve root under O-Arm navigation

目的 探讨O-Arm导航在高位骶骨肿瘤切除中的应用,通过精准外科边界设计,保留骶神经根,分析术中实施策略及与传统切除方式的差异。方法 2020年4月至2020年12月,共有4例接受高位骶骨肿瘤切除,病理类型均为脊索瘤;其中男2例,女2例,平均年龄53.5岁。结果 4例均顺利接受了手术治疗,手术时间3~4h,平均3.2h;失血量800~2000ml,平均1500ml。肿瘤部位及累及范围:S3例,S1例;肿瘤均获得完整切除并经术后病理明确骨切缘阴性。术后均获得早期随访。1例术后出现伤口并发症,给予清创后二期愈合,未发生深部感染;4例均未出现双下肢坐骨神经症状,足跖屈、背伸功能正常;术后4例均出现括约肌功能部分丧失。结论 O-Arm导航引导下,实施高位骶骨肿瘤切除;术中在实时扫描影像数据的引导下,精准实施手术,实现瘤体的完整切除,最大限度地保留神经功能,且不增加手术时间。

Objective To explore the application of O-Arm navigation in the resection of high sacral tumors,preserve the sacral 1 nerve root through accurate surgical boundary design,and analyze the implementation strategy and the differences with the traditional resection method.Methods From April 2020 to December 2020,a total of4 patients underwent resection of high sacral tumors.Pathological type:chordoma.There were 2 males and 2 females,with an average age of 53.5 years.Results All the 4 patients received surgical treatment successfully.The average operation time was 3.2 h (range:3-4 h),and the average blood loss was 1500 ml (range:800-2000 ml).Tumor location and range:S3 cases and S1 case;all tumors were completely removed and confirmed by postoperative pathology,and the bone cutting edge was negative.All patients were followed up early after operation.1 case had wound complications,and secondary healing was achieved after debridement with no deep infection;4 cases had no symptoms of sciatic nerve of both lower limbs,and the functions of plantar flexion and back extension were normal.All patients had partial loss of sphincter function.Conclusions With the guidance of O-Arm navigation,the resection of high sacral tumor can be accurately implemented with real-time scanning image data during the operation to avoid the impact of surgical position on the navigation accuracy,so as to realize the complete resection of tumor and the maximum preservation of nerve function.The perioperative complications are similar to those of traditional surgery.At the same time,it will not increase the operation time because the intraoperative real-time scanning does not need to be registered and verified with the preoperative data.