37例骶骨肿瘤患者的外科治疗经验与要点  

Experience and key points in surgical treatment of 37 patients with sacral tumors

作　　者：许建波[1] 史会明[1] 肖砚斌[1] 李文忠[1] 孙洪瀑[1] 马翔昆 

机构地区：[1]昆明医学院第三附属医院骨科,云南省肿瘤医院,云南昆明650118

出　　处：《中国癌症杂志》2009年第4期305-308,共4页China Oncology

摘　　要：背景与目的:骶骨肿瘤的外科治疗复杂,本文就我科收治的37例骶骨肿瘤治疗经验探讨骶骨肿瘤的外科治疗要点。方法:回顾1999—2007年间我科收治的37例骶骨肿瘤患者,年龄19～78岁,中位年龄51岁,女性17例,男性20例。其中,脊索瘤11例,骨巨细胞瘤8例,转移瘤6例,骨髓瘤4例,神经纤维瘤3例,动脉瘤样骨囊肿2例,骨肉瘤2例,软骨肉瘤1例。病变侵犯S3以下的21例;侵犯S2及以上16例。37例预期生存时间大于6个月,均行外科手术治疗,其中S3及以下部位多采取骶骨肿瘤外科边界切除为主,侵犯S2及以上多采用囊内切刮-脊柱骨盆重建术。结果:全部手术成功,无一例术中死亡,疼痛均较术前缓解,术后患者大小便功能改善11例。26例获得随访,随访4个月至8年,中位数为37个月,6例死于远位转移,3例死于全身衰竭,2例复发再次手术,其余15例恢复正常生活。结论:充分做好严密的止血措施、脊柱稳定性的重建及神经根的保护是手术成功的关键,娴熟的手术操作是成功手术的必要。Background and purpose： There is no standard way to treat sacral tumor with surgery in terms of technology and excision extent. In this article, 37 cases with sacral tumors treated by surgery in our unit were used to investigate the key points to the surgical management of sacral tumors. Methods： We have reviewed the 37 patients of sacral tumors managed from 1999 to 2007 with median age 51 years old （19-78 years old）, 17 cases were female and 20 were male. Of these, there were 11 cases of chordoma, 8 cases of giant cell tumor of bone, 6 cases of metastatic tumor, 4 cases of myeloma, 3 cases of the neurofibroma, 2 cases of aneurysm bone cyst, 2 cases of osteosarcoma and a case of chondrosarcoma. The 37 patients who had been anticipated to survive more than 6 months were operated, some of them with S2 and above （16 patients） received surgery consisting of scraping and cutting in capsule mostly and the reconstruction of the continuity between the spine and the pelvis, while the other patients of tumor located in S3 and below （21 patients） received sacral tumors excision with surgical reconstruction. Results： All patients obtained successful operations, and there was no mortality during the operation. The fecal and urine functions of 11 patients improved after operation, and the pain of all patients was relieved. In the follow-up period of 4 months-8 years with median 37 months, 26 patients were still alive and 15 patients of them had normal life, 6 patients died of tumor metastasis; 3 patients died of other diseases; 2 patients had local failure and received second operation. Conclusion： How to stop bleeding, the reconstruction of the continuity between the spine and the pelvis, the protection of sacral nerve are some of the critical factors for successful oneration.

关 键 词：骶骨 骨肿瘤 手术治疗 

分 类 号：R738.1[医药卫生—肿瘤] R730.56[医药卫生—临床医学]