骶骨骨巨细胞瘤的外科治疗  

Critical surgical techniques for giant cell tumor of sacrum

作　　者：李国东[1] 蔡郑东[1] 付东[1] 陈楷[1] 李健[1] 胡硕[1] 孙伟[1] 孙梦熊[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《中华骨科杂志》2011年第6期646-651,共6页Chinese Journal of Orthopaedics

基　　金：上海市自然科学基金项目（11ZR1428400）

摘　　要：目的探讨骶骨骨巨细胞瘤外科切除边界与局部复发率及骶神经保留节段与神经功能的关系。方法对1996年8月至2008年8月行肿瘤切除的48例骶骨骨巨细胞瘤患者进行回顾性分析，男20例，女28例；年龄19-74岁，平均34．7岁。肿瘤累及S1-S5 4例，S1—S4 7例，S1—S3 15例，S1,2 12例，S2-S5 8例，S3-S5 2例。采用单纯后路29例，前后联合入路19例。整块切除2例，边缘切除12例，边缘切除加刮除25例，刮除9例。术后定期随访，观察局部复发情况与骶神经功能。结果41例随访18-115个月，平均43．5个月。术中出血量550-12000ml，平均3560ml。1例发生良性肺转移，2例发生肉瘤变后死亡。15例肿瘤原位复发，其中整块切除复发率0（0／2）、边缘切除18．2％（2／11）、边缘切除加刮除40．9％（9／22）、单纯刮除66．7％（4，6）。边缘切除局部复发率低于单纯刮除，差异有统计学意义。保留双侧S3神经根者大小便功能障碍发生率7．4％（2／27），保留单侧S3神经根者33．3％（4／12），差异有统计学意义。结论外科切除边界与骶骨骨巨细胞瘤局部复发率相关，在注意保留骶神经根的前提下应以边缘切除为目标；保留双侧S。神经根可使绝大部分患者的括约肌功能得以恢复。Objective To discuss the relations between optimal surgical margin and local recurrence and the impact of preserving segment of sacral nerve root on neural functions based on the clinical and pathological features of giant cell tumor （GCT）. Methods From August 1996 to August 2008, 48 patients with sacral GCT undergoing tumor resection were respectively analyzed, including 20 males and 28 females with an average of 34.7 years （range, 19-74）. The tumors were located in S1-Ss in 4 patients, S1-S4 in 7, S1- S3 in 15, S1, 2 in 12, S2-S5 in 8, and S3-S5 in 2. Surgical methods included single posterior approach in 29 cases, combined anterior-posterior approach in 19. The surgical margins adopted were en-bloc in 2 patients, marginal in 15, marginal and curettage in 25, and curettage in 9. Results Forty-one of 48 cases were successfully followed up, the average time was 43.5 months （range, 18-115）. The average blood loss during surgery was 3560 ml （range, 550-12 000）. Benign lung metastasis occurred in one case 6 years after operation, 2 patients died of malignant transformation. Local recurrence occurred in 15 cases. The recurrence rates in patients with en-bloc resection, marginal resection, marginal resection combined with curettage, and curettage were 0, 18.2%, 40.9%, 66.7%, respectively. The recurrence rate of marginal group was significantly lower than that of the curettage group. Of 27 cases with bilateral S3 nerve root preservation, 2 suffered from urine or fetal dysfunction, with an incidence rate of 7.4%. While 4 of 12 patients with unilateral S3 nerve root preservation suffered from sphincter disturbance, with an incidence rate of 33.3%. The significant difference between groups in nerve root preservation was confirmed. Conclusion Optimal surgical margin for sacral GCT is of great importance to local control of tumor recurrence, the surgical procedure of sacral GCT should aim at the marginal resection on the basis of rational sacral nerve roots preservation; preservation of bilateral S3 nerve ro

关 键 词：巨细胞瘤 骨 骶骨 外科手术 

分 类 号：R738.1[医药卫生—肿瘤]