后路直切口骶尾骨开窗入路切除骶前肿瘤的疗效分析  

Clinical Article Efficacy analysis of posterior straight incision sacrococcygeal fenestration approach for resection of presacral tumor

作　　者：肖伟 王锐[1] 庄源东 陈琰[1] 江研伟[1] 曾群 陈春美[1] Xiao Wei;Wang Rui;Zhuang Yuandong;Chen Yan;Jiang Yanwei;Zeng Qun;Chen Chunmei(Department of Neurosurgery,Union Hospital of Fujian Medical University,Fuzhou 350000,China;Department of Neurosurgery,Xiangtan Central Hospital,Xiangtan 411100,China)

机构地区：[1]福建医科大学附属协和医院神经外科,福州350000 [2]湘潭市中心医院神经外科,湘潭411100

出　　处：《中华神经外科杂志》2022年第3期276-279,共4页Chinese Journal of Neurosurgery

基　　金：福建省卫生教育联合攻关计划(2019-WJ-08)。

摘　　要：目的初步探讨后路直切口经骶尾骨开窗入路切除骶前肿瘤的疗效。方法回顾性分析2018年4月至2020年4月福建医科大学附属协和医院神经外科收治的9例骶前肿瘤患者的临床资料,所有患者均行后路直切口经骶尾骨开窗入路切除骶前肿瘤。统计所有患者的手术切口长度、术中出血量、手术时长及住院时长。术后复查腰骶部CT或MRI,判断肿瘤切除程度。出院后对所有患者行门诊随访,随访内容包括:复查腰骶部CT或MRI,判断肿瘤复发情况;行视觉模拟量表(VAS)评分,评估疼痛改善情况。结果9例患者术中均未损伤输尿管和大动脉,手术切口的长度[M(范围)]为8(2~12)cm,术中出血量[M(范围)]为50(30~500)ml,手术时间[M(范围)]为180(100~390)min,住院时间[M(范围)]为7(5~14)d。术后1例患者伤口周围出现水泡,经积极治疗后愈合。术后复查腰骶部CT或MRI显示,8例为肿瘤完全切除,另1例为大部分切除。术后病理学检查结果显示,神经鞘瘤4例,脊索瘤3例,肠源性腺癌1例,高分化软骨肉瘤1例。9例患者的随访时间[M(范围)]为21(13~37)个月。随访期间,1例患者肿瘤复发(脊索瘤),再次行手术治疗;另8例未复发。至末次随访,9例患者的VAS评分[M(范围)]为0(0~5)分,较术前[7(6~8)分]显著下降(u=-2.53,P=0.011)。结论后路直切口经骶尾骨开窗入路切除骶前肿瘤的损伤小,术中出血量少、术后并发症发生率低且术后恢复快。Objective To preliminarily explore the efficacy of posterior straight incision sacrococcygeal fenestration for resection of presacral tumors.Methods We retrospectively analyzed the clinical data of 9 patients with presacral tumors admitted to the Department of Neurosurgery,Union Hospital Affiliated to Fujian Medical University from April 2018 to April 2020.The length of the incision,intraoperative blood loss,operation time and hospital stay of all patients were counted.Postoperative CT or MRI of the lumbosacral region was performed to determine the degree of tumor resection.After discharge,outpatient follow-up was performed for all patients.The follow-up included re-examination of lumbosacral CT or MRI to determine tumor recurrence and evaluation of pain improvement using the visual analog scale(VAS).Results The ureter or aorta was not damaged during the operation in 9 patients.The length of the incision[M(range)]was 8(2.0-12.0)cm,the median intraoperative blood loss[M(range)]was 50(30-500)ml,the operation time was 180(100-390)min,and the hospital stay[M(range)]was 7(5.0-14.0)days.One patient developed blisters around the wound after operation,which healed after active treatment.Postoperative re-examination of lumbosacral CT or MRI showed that complete tumor resection was achieved in 8 cases and major resection in 1 case.Postoperative pathological examination revealed 4 cases of schwannoma,3 cases of chordoma,1 case of intestinal adenocarcinoma,and 1 case of well-differentiated chondrosarcoma.The follow-up time[M(range)]of 9 patients was 21(13-37)months.During the follow-up period,1 patient had tumor recurrence(chordoma)and underwent surgery again;the other 8 patients did not have recurrence.At the last follow-up,the VAS[M(range)]score of 9 patients was 0(0-5),which was significantly lower than that before operation[7(6-8),u=-2.53,P=0.011].Conclusion Posterior straight incision sacrococcygeal fenestration for resection of presacral tumors seems to be associated with less damage,less intraoperative blood loss,low

关 键 词：治疗结果 骶前肿瘤 后路手术 骶尾骨开窗 

分 类 号：R739.93[医药卫生—肿瘤]