经旁骶尾入路改良手术治疗成人骶前良性肿瘤  

Improved surgery for adult presacral benign tumors via parasacral approach

作　　者：唐浩[1] 贺平[2] 徐良[1] 黄素[1] 曾晓梅[1] TANG Hao;HE Ping;XU Liang;HUANG Su;ZENG Xiaomei(The Third People's Hospital of Yibin, Yibin 644000, Sichuan, China;Chengdu Anorectal Hospital, Chengdu 610017, China)

机构地区：[1]宜宾市第三人民医院,四川宜宾644000 [2]成都肛肠专科医院,四川成都610017

出　　处：《西部医学》2021年第8期1225-1229,共5页Medical Journal of West China

基　　金：宜宾市科技计划(重点)项目(2017SF008-3)。

摘　　要：目的探讨经旁骶尾入路改良手术治疗成人骶前良性肿瘤的临床效果。方法回顾性分析宜宾市第三人民医院2010年6月~2020年5月收治的9例成人骶前良性肿瘤患者临床资料,患者均采用改良手术方式:将传统的俯卧折刀位经旁骶尾入路改为左侧卧位右下肢屈曲的经旁骶尾入路,传统切除骶尾骨增加显露的方式改为完整保留骶尾骨,对部分肿瘤与周围致密粘连的患者在致密粘连区行肿瘤内层上皮切除,所有患者肿瘤切除后重建肛尾韧带及盆底肌,完成盆底解剖复位。结果9例患者全部保留骶尾骨及完整重建盆底;7例完整切除,2例大部切除+局部肿瘤内层上皮切除;8例一期愈合,1例院外手术后感染伴直肠内瘘经分期手术痊愈;所有患者随访1~11年无复发。结论经旁骶尾入路改良手术治疗成人骶前良性肿瘤,可明显减少创伤及完全恢复盆底稳定性,同时减少直肠及骶前损伤的并发症,适用于囊性及囊实性骶前良性肿瘤和部分实性良性肿瘤。Objective To investigate the clinical effect of modified surgery via paracral caudal approach in the treatment of benign presacral tumors in adults.Methods The clinical data of 9 adult patients with presacral benign tumors admitted to the third people's Hospital of Yibin City from June 2010 to May 2020 were retrospectively analyzed.All patients were treated with improved surgical methods.The traditional prone folding knife position through the parasacrococcygeal approach was changed to the left lying position and the right lower limb flexion through the parasacrococcygeal approach.The traditional way of sacrococcygeal bone resection to increase exposure was changed to complete sacrococcygeal bone preservation.For some patients with dense adhesion around the tumor,the tumor inner layer epithelial resection was performed in the area of dense adhesion.After tumor resection,the anococcal ligament and pelvic floor muscle were reconstructed in all patients to complete the anatomical reduction of pelvic floor.Results Sacrococcygeal bone was preserved and pelvic floor was reconstructed in all 9 patients.7 cases were completely resected,2 cases were subtotal resection and local tumor resection,8 cases were primary healing,and 1 case was cured by staged operation.All patients were followed up for 1 to 11 years without recurrence.Conclusion The modified operation can significantly reduce the trauma and completely restore the stability of pelvic floor,and reduce the complications of rectum and presacral injury.It is suitable for cystic and solid presacral benign tumors and partial solid benign tumors.

关 键 词：骶前良性肿瘤 经旁骶尾入路 改良手术 成人 

分 类 号：R735[医药卫生—肿瘤]