明胶海绵靶血管栓塞后手术治疗原发性骶骨肿瘤  

Surgical Treatment of Sacral Primartumors after Transcatheter Arterial Embolization with gelfoam

作　　者：杨惠林[1] 王根林[1] 朱立帆[1] 陈康武[1] 王斌[1] 陆俭[1] 季一鸣[1] 唐天驷[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国肿瘤外科杂志》2009年第1期21-24,共4页Chinese Journal of Surgical Oncology

基　　金：江苏省135重点学科基金资助项目(RC2003091)

摘　　要：目的探讨明胶海绵靶血管栓塞后手术治疗骶骨脊索瘤与骶骨巨细胞瘤的临床疗效。方法收集1994年1月至2008年1月靶血管栓塞后手术治疗61例原发性骶骨肿瘤患者的临床资料，对资料完整的35例骶骨脊索瘤与11例骨巨细胞瘤进行回顾性研究。所有患者术前均用明胶海绵进行靶血管栓塞，栓塞后平均1．5d内后方入路手术切除肿瘤。记录术中出血量与输血量，并观察大小便功能和肿瘤复发情况。结果所有患者瘤体均顺利切除，术中出血平均1230mL（200～5100mL），平均输血量1000mL（0～4200mL）。平均随访53．6个月（8～156个月），脊索瘤患者复发11例（31．4％），其中死亡5例（14．3％），骨巨细胞瘤复发1例（9．1％）。保留双侧S1-3神经根或保留双侧S1-2神经根及一侧S3神经根者术后大小便功能基本正常，余均有不同程度的大小便功能障碍。结论明胶海绵靶血管栓塞后手术治疗原发性骶骨肿瘤，可有效减少术中出血，增加肿瘤切除率和彻底切除的可能性；对肿瘤较大的患者后方入路仍能较好完成手术，疗效满意。Objective To study the clinical efficacy of surgical treatment for sacral chordoma and bone giant cell tumors. Methods The data of 35 patients with sacral chordomas and 11 patients with bone giant cell tumors treated by operation in our hospital from January 1994 to January 2008 were retrospectively studied. All the cases were operated with posterior approach within average 36 hours after transcatheter arterial embolization with gelfoam. The blood loss and transfusion volumn during operation were reviewed. The sphincter muscle function of bladder and bowl, and tumor recurrence was observed. Results The volumn of blood loss ranged from 200 -5 100 mL （average 1 230 mL）. The volumn of blood transfusion ranged from 0 -4 200 mL （average 1 000 mL）. All the cases were followed up for an average of 53.6 months （ ranging from 8 to 156 months）. At the final follow-up, 11 of 35 chordomas recurred （31.4%） and 5 cases died of tumor （ 14.3% ）. 1 of 11 bone giant cell tumors recurred （9.1% ） but no cases died of tumor. The sphincter muscle function of bladder and bowl was good in the patients with bilateral S1-3 reserved or bilateral S1-2 and unilateral S3 reserved, while the function of sphincter muscle impaired in the other patients. Conclusions Preoperative arterial embolization is effective in decreasing intraoperative blood loss and can lead to excellent results. Even if the tumor is relatively huge, the tumor can be removed sucessfully by posterior approach.

关 键 词：骶骨 脊索瘤 骨巨细胞瘤 手术 栓塞 

分 类 号：R738.1[医药卫生—肿瘤] R441.7[医药卫生—临床医学]