腹主动脉阻断联合内固定治疗高位骶骨肿瘤的临床观察  

Clinical study of abdominal aorta blockage combined with internal fixation method on superior sacral tumors

作　　者：张晋煜[1,2,3] 许建波[1,2,3] 袁涛[1,2,3] 马翔[1,2,3] 杨腾蛟[1,2,3] 

机构地区：[1]昆明昆明医学院第三附属医院 [2]云南省肿瘤医院骨科,650118 [3]云南省骨与软组织肿瘤诊疗研究中心,650118

出　　处：《临床肿瘤学杂志》2011年第8期732-735,共4页Chinese Clinical Oncology

摘　　要：目的探讨腹主动脉阻断联合内固定重建技术治疗高位骶骨肿瘤的临床疗效。方法本院于2006年1月至2009年12月收治38例骶骨肿瘤患者,采用腹主动脉阻断下骶骨肿瘤切除＋骨水泥填充＋改良Gaveston内固定技术重建。原发性肿瘤29例,转移癌9例。肿瘤位于S1椎体14例,S2椎体12例,S1~S2椎体12例。记录术中出血量、切口愈合、疗效、并发症以及随访情况。结果手术时间330~420m in,手术出血量为（2400±1656）m l,无术中死亡。术后患者腰骶部疼痛及神经功能有不同程度改善。7例术后出现排尿困难,半年后恢复;6例术后切口感染及延期愈合。术后随访6~36个月,复发3例,死亡2例。1例脊索瘤患者术后半年复发,1例尤文肉瘤患者术后2月复发,1例转移癌患者3月复发。2例转移癌患者分别于术后14个月、20个月因全身衰竭而死亡。结论腹主动脉阻断联合肿瘤切除＋骨水泥填充＋改良Gaveston内固定技术是治疗高位骶骨肿瘤的有效手段,该术式可以减少出血,保证骶骨肿瘤切除,提高手术的安全性,有利于骨盆和脊柱的稳定性以及神经功能的恢复,术后可早期活动。Objective To investigate the efficacy of abdominal aorta blockage and the internal fixation method on superior sacral tumors. Methods From January 2006 to December 2009, 38 patients with superior sacral tumor were underwent tumorectomy under abdominal aorta blockage plus bone cement implantation plus modified Gaveston technology, including 29 primary tumors and 9 metastasis cancers,and with 14 cases in S1 , 12 in S2 , and 12 with S1 -S2. Loss of blood, shock or death and sacral nerves injury were observed. Results The average operating time was 330-420min,the volume of bleeding was as （2400±1656） ml, and no patient died during operations. The results of surgery were satisfactory with the lumbosacral pain reduction. Seven cases of dysuria improved in different degrees after 6 monthes, and 6 cases experienced perative infection and delayed healing. The follow up was 6-36 months with 3 cases of recurrence and 2 cases of death. One case with chordoma recurred 6 months after operation, 1 case with metastasis cancer 3 months after operation, and 1 case with Ewing＇ sarcoma 2 months after operation. Two cases with metastasis cancer died of exhaustion 14 and 20 months after operation respectively. Conclusion Tumorectomy under abdominal aorta blockage plus bone cement implanta- tion plus modified Gaveston technology is an effective method to diminish bleeding as resection of superior sacrum tumor. The technique about lumbosacral stability after tumor excision with gaveston internal fixation is helpful to improve sacral nerves injury and early mobilization.

关 键 词：腹主动脉阻断 骶骨肿瘤 改良Gaveston内固定 骨盆稳定 神经功能 

分 类 号：R738.1[医药卫生—肿瘤]