超选择肿瘤动脉栓塞联合单纯后路手术切除治疗骶骨脊索瘤的疗效观察

The efficacy of superselective tumor arterial embolization combined with simple posterior approach resection for the treatment of sacral chordoma

目的:探讨肿瘤动脉栓塞后手术切除治疗原发性骶骨脊索瘤的疗效。方法:回顾性分析我院2012年01月至2018年01月收治的30例原发性骶骨脊索瘤患者。其中19例采用DSA引导下超选择肿瘤动脉栓塞联合骶后方入路一期完全切除骶骨脊索瘤(A组),11例未行肿瘤动脉栓塞直接采用单纯后路一期手术切除(B组)。对两组患者的手术时间、术中出血量、术后引流量、术后引流管拔除时间、并发症发生率及术后肿瘤复发率进行比较分析。结果:所有患者均顺利完成手术,无术中直肠损伤、失血性休克或死亡,A组手术时间155~248 min(202.42±29.75)min,术中出血量685~1885 mL(1349.84±282.84)mL,术后引流量150~300 mL(227.26±35.82)mL,术后拔管时间7~9 d(7.42±0.61)d;B组手术时间220~300 min(271.45±21.78)min,术中出血量890~2400 mL(1846.45±396.38)mL,术后引流量220~330 mL(284.09±38.26)mL,术后拔管时间8~10 d(9.45±0.69)d。A组手术时间、术中出血量、术后引流量及术后拔管时间均小于B组,差异均有统计学意义(P<0.001)。A组并发症发生率为26.3%,术后肿瘤复发率为31.6%;B组并发症发生率为27.3%,术后肿瘤复发率为27.3%。两组患者的并发症发生率及术后肿瘤复发率比较,差异均无统计学意义(P>0.05)。结论:DSA引导下超选择肿瘤动脉栓塞联合单纯骶后方入路可以一期完全切除原发性骶骨脊索瘤,取得较满意的临床效果。

Objective:To investigate the curative effect of surgical resection after tumor arterial embolization for primary sacral chordoma.Methods:30 cases of primary sacrum chordoma treated in our hospital were retrospectively analyzed from January 2012 to January 2018.Superselective tumor arterial embolization under digital subtraction angiography(DSA)was performed preoperatively in 19 cases,then using a posterior approach to remove the tumor completely(group A),while 11 cases only used a posterior approach to remove the tumor completely(group B).Compared the operation time,the intraoperative blood loss,the postoperative drainage blood,the postoperative extubation time,the complication and the postoperative tumor recurrence rate between the two groups.Results:All the patients successfully completed the operation.None of case rectal injury shock or died during operation.The average operation time of group A was(202.42±29.75)min(range:155~248 min),the average intraoperative blood loss of group A was(1349.84±282.84)mL(range:685~1885 mL),the average postoperative drainage blood of group A was(227.26±35.82)mL(range:150~300 mL)and the average postoperative extubation time of group A was(7.42±0.61)d(range:7~9 d).The average operation time of group B was(271.45±21.78)min(range:220~300 min),the average intraoperative blood loss of group B was(1846.45±396.38)mL(range:890~2400 mL),the average postoperative drainage blood of group B was(284.09±38.26)mL(range:220~330 mL)and the average postoperative extubation time of group B was(9.45±0.69)d(range:8~10 d).The operation time,]intraoperative blood loss and postoperative drainage volume in group A were less than those in group B,and the differences were statistically significant(P<0.001).The complication rate between group A and group B was 26.3%vs 27.3%,and the postoperative tumor recurrence rate between the two groups was 31.6%vs 27.3%.There was no statistically significant difference in the complication rate and postoperative tumor recurrence rate between the two groups(P>0.05).Conclusion:DSA guided superselective tumor arterial embolization combined with simple posterior sacral approach can completely remove primary sacral chordoma in one stage,and achieve satisfactory clinical results.