骶骨肿瘤切除术后软组织重建的策略和效果  

Soft tissue reconstruction strategy for sacral tumor resection

作　　者：沙漠[1] 丁真奇[1] 洪海森[1] 聂凯[2] 林吓聪[3] 邵建川 宋伟[1] 康两期[1] Sha Mo;Ding Zhenqi;Hong Haisen;Nie Kai;Lin Xiacong;Shao Jianchuan;Song Wei;Kang Liangqi(Orthopedic Center of People′s Liberation Army,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China;Department of General Surgery,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China;Department of Urology,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China;Department of Plastic Surgery,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China)

机构地区：[1]厦门大学附属东南医院联勤保障部队第九〇九医院全军骨科中心,漳州363000 [2]厦门大学附属东南医院联勤保障部队第九〇九医院普外科,漳州363000 [3]厦门大学附属东南医院联勤保障部队第九〇九医院泌尿外科,漳州363000 [4]厦门大学附属东南医院联勤保障部队第九〇九医院整形科,漳州363000

出　　处：《中华外科杂志》2022年第12期1085-1092,共8页Chinese Journal of Surgery

基　　金：联勤保障部队第九〇九医院院内基金(22YZ03)。

摘　　要：目的探讨不同平面骶骨肿瘤切除术后软组织重建的临床策略和效果。方法回顾性分析厦门大学附属东南医院(联勤保障部队第九〇九医院)2012年6月至2021年6月连续收治的27例因骶骨原发或继发肿瘤行骶骨肿瘤切除术和软组织重建术患者的临床资料。男性11例,女性16例,年龄(46.2±23.6)岁(范围:16~72岁)。根据肿瘤部位和组织缺损大小选择骶棘肌、臀大肌、腹直肌等进行软组织重建,并进行术后随访。收集患者的手术方法、术中情况、并发症、疾病转归等资料并进行分析。结果27例骶骨肿瘤患者中,肿瘤平面位于S18例,S25例,S3及以下14例;肿瘤体积≤400 cm312例,>400 cm315例;手术时间[M(IQR)]100(90)min(范围:70~610 min);术中出血量800(1600)ml(范围:400~6500 ml)。软组织重建采用经腹腹直肌转移修复术2例,腹膜外腹直肌转移修复术1例,臀大肌转移修复术5例,臀大肌推移修复术13例,骶棘肌转移修复术6例。术后6例发生并发症,其中切口感染1例,皮缘坏死4例,术后3年因内固定物断裂发生迟发型感染1例,感染均治愈。术后随访时间为(35±21)个月(范围:6~98个月),其中复发6例,2例尤因肉瘤患者术后1年发生肺转移后死亡,4例转移癌患者死于原发病,其余患者无病生存。结论根据骶骨肿瘤位置、组织缺损大小等选择不同的软组织重建方式填塞肿瘤切除后死腔,可取得较好效果。Objective To investigate the clinical strategy and effect of soft tissue reconstruction after sacral tumor resection in different planes.Methods The data of 27 consecutive patients who underwent primary or secondary sacral tumor resection and soft tissue reconstruction from June 2012 to June 2021 at Dongnan Hospital of Xiamen University(the 909th Hospital)were retrospectively analyzed.There were 11 males and 16 females,aged(M(IQR))(46.2±23.6)years(range:16 to 72 years).Sacrospinous muscle,gluteus maximus and vertical rectus abdominis muscle flap were selected for soft tissue reconstruction according to the tumor site and the size of tissue defect.the postoperative follow-up was performed.The operative methods,intraoperative conditions,complications and disease outcomes were summarized.Results Among the 27 patients with sacral tumor,the tumor plane was located in S1 in 8 cases,S2 in 5 cases and S3 or below in 14 cases.There were 12 patients with tumor volume≤400 cm3 and 15 patients with tumor volume>400 cm3.Operation time was 100(90)minutes(range:70 to 610 minutes),intraoperative blood loss was 800(1600)ml(range:400 to 6500 ml).Soft tissue reconstruction was performed by transabdominal rectus abdominis transfer repair in 2 cases,extraperitoneal rectus abdominis transfer repair in 1 case,gluteus maximus transfer repair in 5 cases,gluteus maximus advancement repair in 13 cases,and sacrospinous muscle transfer repair in 6 cases.Postoperative complications occurred in 6 cases,including 1 case of incision infection,4 cases of skin border necrosis,and 1 case of delayed infection due to fracture of internal fixator 3 years after operation,all of them were cured.The follow-up time was(35±21)months.Among the patients,6 patients had recurrence,2 patients with Ewing sarcoma died of lung metastasis 1 year after operation,4 patients with metastatic cancer died of primary disease,and the remaining patients survived without disease.Conclusion Choosing different soft tissue reconstruction strategies according to sacral tumor

关 键 词：骨肿瘤 骶骨 软组织重建 深部感染 

分 类 号：R738.1[医药卫生—肿瘤]