原发性骶前肿瘤42例诊治分析  

Diagnosis and surgical treatment for primary presacral tumors

作　　者：徐向明[1] 陆森[1] 张国良[1] 徐加鹤[1] 林建江[1] 

机构地区：[1]浙江大学医学院附属第一医院肌肠外科,杭州310003

出　　处：《中华普通外科杂志》2016年第1期8-10,共3页Chinese Journal of General Surgery

摘　　要：目的探讨骶前肿瘤的临床表现及外科诊治经验。方法回顾性分析浙江大学医学院附属第一医院肛肠外科2013年1月至2015年5月收治的42例原发性骶前肿瘤的临床资料。结果42例患者中16例无明显临床症状，26例诉骶尾部或下腹部不适，或排便排尿困难。肛查指检发现病灶者38例，阳性率达90％（38／42）。42例患者中行手术治疗36例，接受放疗1例，放弃手术治疗5例。28例经腹手术，4例经骶手术，3例经腹经骶联合手术，1例经腹会阴联合手术。31例完整切除病灶，5例有肿瘤残留。术中发生骶前大出血3例，迟发性出血再次手术1例；切口感染经引流换药后好转2例；术后发生臀部或下肢麻木不适3例；高热不退1例，经使用亚胺培南西司他丁钠后好转。结论骶前肿瘤发病率低，早期发现较困难。直肠指检结合CT或MRI能够确诊，且均应接受治疗。实性或囊实性肿瘤需术前活检，以指导合理的术前辅助治疗。Objective To investigate the clinical characteristics and surgical treatment for primary presacral tumors. Methods The clinical data of 42 patients of primary presacral tumors from January 2013 to May 2015 were analysed retrospectively. Results Of the 42 patients, 16 cases were asymptomatic while 26 patients had discomfort at the sacral or abdominal region, or difficulty in urinating or defecation. 90% of the cases were digital rectum examination （ DRE ） positive. Among the 42 patients 36 cases underwent surgical treatment, 1 case underwent radiotherapy, 5 cases refused surgical treatment. Among those receiving surgical resection, 28 cases had trans-abdominal surgery and 4 cases had trans-sacral surgery, while 3 cases had trans-abdominal ＆ trans-sacral surgery, 1 case had trans-abdominal and perineal surgery. Tumors were completely resected in 31 cases, and palliatively resected in 5 cases. 3 cases suffered from intra-operative presacral hemorrhage. 1 case with delayed hemorrhage required surgical intervention. 2 cases from incision infection recovered after wound disinfection and dressing, 3 cases had postoperative hip or leg numbness; 1 case with high fever was cured by intensive antibiotics treatment. Conclusion The low incidence of presacral tumors makes early detection difficult. A diagnosis can be obtained by a positive DRE combined with CT or MRI results. Resection is a therapy of choice after biopsies.

关 键 词：畸胎瘤 神经鞘瘤 平滑肌瘤 骶前肿瘤 

分 类 号：R738[医药卫生—肿瘤]