单纯后路骶骨整块切除治疗S_2水平原发恶性骶骨肿瘤  

Subtotal sacrectomy for treatment of primary malignant sacral tumors involving S_2 via posterior-only approach

作　　者：林斌[1] 赵忠胜[1] 庄泽民[1] 史吉胜[1] 陈志达[1] 薛超[1] 蔡弢艺[1] 郭志民[1] 

机构地区：[1]解放军第175医院(厦门大学附属东南医院)全军骨科中心,福建漳州363000

出　　处：《临床骨科杂志》2016年第2期167-171,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨单纯后路骶骨整块切除、纱布填塞技术治疗累及S2水平原发恶性骶骨肿瘤的手术入路、切口选择、手术方法及并发症。方法采用单纯后路骶骨整块切除、纱布填塞技术治疗9例累及S2水平的原发恶性骶骨肿瘤患者,均未行腰骶部重建,其中脊索瘤6例,Ewing肉瘤2例,软骨肉瘤1例。用VAS评分评价手术前后疼痛程度,用改良Biagini评分评价手术前后神经功能。结果 9例患者瘤体均顺利切除,截骨水平位于S26例,S33例。手术时间150320（221.7±35.6）min,术中出血8001 800（1 144±332.5）ml。患者均获得随访,时间2561个月。4例出现皮肤坏死后伤口感染,二次手术后伤口愈合。术前9例神经功能基本正常;术后2例括约肌功能基本正常,6例括约肌功能障碍、排尿排便刺激感存在,1例括约肌功能丧失、不能感觉排便刺激。6例术后存在神经性疼痛,治疗4个月后VAS评分为0.53分。1例Ewing肉瘤与1例软骨肉瘤复发;1例脊索瘤患者术后32个月死于心血管系统疾病。结论单纯后路骶骨整块切除、纱布填塞技术能顺利完成S2水平骶骨整块切除手术,方法可靠,可达到彻底的肿瘤切除边缘;但其并发症发生率较高,对患者大小便功能影响较大。Objective To investigate the surgical indication,approach,incision selection,resection methods and complications of subtotal sacrectomy via posterior-only approach and gauze packing technique for treament of primary malignant sacral tumors involving S2. Methods 9 cases of primary malignant sacral tumors involving S2 were treated by sacrectomy via posterior-only approach,gauze packing technique and no iliolumbar reconstruction. Pathological diagnosis： 6 cases of chordoma,2 cases of Ewing sarcoma and 1 case of chondrosarcoma. Preoperative and postoperative VAS and improved Biagini scores were measured to evaluate the curative effect. Results 6 tumors in S2 level and 3tumors in S3 level were successfully removed. Operative time was 150 320（ 221. 7 ± 35. 6） minutes,intraoperative bleeding was 800 1 800（ 1 144 ± 332. 5） ml. The follow-up time was 25 61 months. Wound infection after skin necrosis was observed in 4 patients,wound got healing after the second operation. All patients’ nerve function were essentially normal preoperatively. Sphincter dysfunction in 6 cases and loss of sphincter function in 1 case postoperatively. Six patients existed postoperative neuropathic pain,VAS was 0. 5 3 points after treatment. 1 case of Ewing sarcoma and 1 case of chondrosarcoma recurred locally,1 case of chordoma died from cardiovascular system disease in 32 months postoperatively. Conclusions Subtotal sacrectomy via posterior-only approach and gauze packing technique is an effective way to treat the primary malignant sacral tumors involving S2 with the complete surgical resection boundary. However,the occurrence rate of postoperative complication is high,which has great influence on patients’ postoperative shit control and urinary continence function.

关 键 词：单纯后路 骶骨肿瘤 骶骨切除 

分 类 号：R738.1[医药卫生—肿瘤] R687.3[医药卫生—临床医学]