经S_(3～5)双开门的骶前病变手术入路  

NEW SURGICAL APPROACH FOR PRESACRAL LESION BY DOUBLE DOOR VIA S_(3～5)

作　　者：李康仁[1] 秦辉[1] 陆思伟[1] 关晋龙[1] 余彬[1] 邓宁[1] 

机构地区：[1]成都市第三人民医院骨科,成都610031

出　　处：《中国修复重建外科杂志》2009年第4期412-414,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探索一种新的骶前病变切除手术入路——经S3～5双开门途径。方法2007年6月-2008年1月,收治5例骶前病变患者。患者均为女性;年龄56～84岁。临床表现:肛门坠胀1例,排大便困难及大便带血2例,无症状2例。指肛检查:2例触及直肠包块,3例骶前肿瘤未能触及包块。B超、CT、MRI等检查提示骶前占位3例,直肠肿瘤2例。病变组织大小4cm×3cm×3cm～20cm×15cm×13cm。病程12～50d,平均18d。采用经S3～5双开门途径暴露病灶,常规方法完整切除。结果5例手术顺利,术中未发生骶前静脉丛大出血、直肠损伤、盆腔神经直接损伤、盆底结构破坏等。入路时间12～28min,平均20min;入路时出血30～130mL,平均80mL;手术时间80～120min,平均105min;术中出血100～350mL,平均280mL。术后切口均Ⅰ期愈合。术后切除组织病理检查示骶前畸胎瘤、皮样囊肿、梭状细胞瘤各1例,直肠管状绒毛状腺瘤2例。术后出现不同程度会阴部感觉减退,无大小便失禁。6个月后感觉减退者全部恢复,X线片示开窗骶骨均骨性愈合。5例均获随访,随访时间6～13个月。无骶骨缺损及骨盆稳定性破坏,无骶髂关节炎发生,B超、CT或MRI检查未见病变复发。结论经S3～5双开门的骶前病变手术入路术野浅、暴露充分,不造成骶骨缺损和严重骶神经损伤,具有操作简便、安全、创伤少、术后恢复快等优点。Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients （56-84 years old） with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size of the lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days （average 18 days）. All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes （average 20 minutes） and the blood loss for approach was 30-130 mL （average 80 mL）; and the operation time was 80-120 minutes （average 105 minutes） and the blood loss during operation was 100-350 mL （average 280 mL）. All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe su

关 键 词：手术入路 骶前病变 双开门 

分 类 号：R687.3[医药卫生—骨科学]