原发性骶前肿瘤的手术切除(附20例临床分析)

目的总结原发性骶前肿瘤的诊断、手术方法及主要并发症。方法回顾性分析20例原发性骶前肿瘤患者资料,临床表现无特异性,经直肠指诊、B超、CT确诊,均行手术切除,其中经腹前切除10例,经骶尾部切除9例,经腹骶尾部联合入路切除1例。结果肿瘤完整切除17例,大部切除3例,其中联合邻近脏器切除3例。发生围手术期并发症7例,其中大出血3例,误伤直肠1例,术后骶尾部切口坏死并感染2例,术后排尿困难1例。16例患者平均随访15(3~36)月,肿瘤完整切除的患者获随访14例,复发2例,死亡1例;大部切除的患者获随访2例,均已死亡。结论原发性骶前肿瘤早期诊断困难,手术时应注意选择合适的入路,良性肿瘤和低度恶性肿瘤应完整切除,并积极防治骶前静脉丛大出血等并发症。     

骶尾部横切口骶前肿瘤切除的手术探讨

目的探讨经骶尾部横切口行骶前肿瘤切除的方法,总结其临床诊治体会。方法回顾性总结2003年1月~2012年1月手术治疗的56例骶前肿瘤患者的临床资料。均采用骶尾部横切口、离断骶尾关节进入骶前间隙,游离肿瘤两侧以及上下极,再游离并离断与盆腔脏器的紧密连接,切除肿瘤,术后放置负压引流。结果所有病例均完整切除肿瘤,术中出血平均110(30~200)ml,手术操作时间平均80(60~150)min,住院时间平均8(6~14)d,无盆腔脏器(直肠、膀胱、女性生殖器官等)损伤。术后恢复顺利,无切口感染,无明显骶前积液,均获得临床治愈;随访8年以上12例,5年以上18例,3年以上20例,1年以上6例,均未见复发。术后病理诊断:囊肿或上皮样囊肿21例,良性畸胎瘤19例,孤立性纤维性肿瘤4例,良性间质瘤3例,神经鞘瘤2例,副节瘤2例,淋巴管瘤2例,苗勒氏瘤1例,恶性畸胎瘤1例,恶性间质瘤1例。结论经骶尾部横切口切除骶前肿瘤是一种安全有效的手术入路和操作方法,值得进一步推广应用。     

原发性骶前肿瘤的诊断与手术治疗（附8例临床分析）

为探讨原发性骶前肿瘤的诊断和手术方法,分析2007-2010年治疗的8例原发性骶前肿瘤患者的临床资料。结果显示,5例经骶尾部切除,1例经腹切除,1例经腹骶联合切除,1例经腹会阴联合切除。术后病理类型：表皮样囊肿2例,皮样囊肿（良性畸胎瘤）1例,脂肪瘤1例,平滑肌瘤1例,淋巴管囊肿1例,恶性纤维组织细胞瘤1例,恶性畸胎瘤1例。术后无严重并发症。随访12～24个月,无死亡病例。结果表明：（1）直肠指诊、直肠腔内超声、CT检查、MRI检查对术前评估有重要意义;（2）原发性骶前肿瘤应行手术切除,根据肿瘤情况选择手术方法,完整切除肿瘤。     

骶尾部藏毛窦诊断与治疗

目的 探讨骶尾部藏毛窦的临床特点、诊断与治疗.方法 2010年10月至2013年1月收治骶尾部藏毛窦5例,5例均骶尾部感染反复发作,待炎症消退后均行藏毛窦一期切除缝合术.结果 5例病理检查结果诊断为藏毛窦,3例术后I期愈合,2例术后切口轻度裂开,经换药后治愈.随访6～12个月均无复发.结论 藏毛窦疾病容易误诊,术前应仔细检查,明确手术范围,彻底手术切除是预防复发的关键.     

骶前发育性囊肿22例诊治经验总结

目的 总结骶前发育性囊肿的临床特点及诊治经验.方法 回顾性分析1989年1月至2008年12月收治的22例骶前发育性囊肿患者的临床资料,探讨骶前发育性囊肿的临床特点及诊治经验.结果 本组患者中,男性8例,女性14例,确诊时年龄18～72岁,中位年龄29.5岁.根据术中测量,囊肿直径(8.3±2.7)cm.包括表皮样囊肿6例,皮样囊肿4例,畸胎瘤12例(2例伴恶变).手术方式为经骶尾部入路18例,经腹手术3例,经腹-骶尾部联合入路手术1例.各术式的手术时间与出血量分别为:改良Kraske术(142±43)min/(192±149)ml,Mason术(102±27)min/(54±37)ml,经腹手术(147±25)min/(117±76)ml,1例联合入路手术为360 min/1000 ml.并发症为:骶尾部入路组术中骶前静脉丛出血1例(6.3%),术后伤口感染1例(6.3%);联合入路组术后骶尾部伤口感染1例;经腹手术组无严重并发症.术后所有患者均获得随访,平均随访40个月(9～92个月).20例良性病例中复发2例,其中经骶尾部入路1例(复发率5.9%),经腹手术1例.结论 骶前发育性囊肿虽生长缓慢,但有一定恶变风险,延迟治疗可增加日后手术切除的难度,故一经发现,应以积极、彻底的手术切除为原则.经骶尾部入路直达肿瘤部位,创伤小,并发症少,必要时可与经腹手术联合应用,是治疗骶前发育性囊肿的理想术式.     

骶尾部藏毛窦84例诊治体会

目的总结骶尾部藏毛窦的诊断和治疗方法。方法回顾性分析我院2007年1月至2011年1月期间收治的84例骶尾部藏毛窦病例的诊治过程,并结合国内、外相关文献报道进行分析、总结。对骶尾部藏毛窦复发者及瘘道走形长度大于5 cm者采用窦道切除切口敞开术,完整切除病变组织,予以康复新液纱条每日湿敷换药治疗;无复发者且瘘道走形长度小于5 cm者采用切除一期缝合,切口褥式缝合,消灭死腔。结果采用切除一期缝合术者36例,窦道切除切口敞开术者48例。有2例切除一期缝合术者术后半年复发,行窦道切除切口敞开术后以康复新液换药而愈;其余82例均一次性手术治愈。切除一期缝合的伤口愈合时间为14～35 d,平均为26 d;窦道切除切口敞开愈合时间为30～45 d,平均37 d。无一例发生并发症。随访1年以上均无复发。结论术前完善相关检查,明确诊断,根据病情选择合适的手术治疗方式,以及围手术期的合理护理能最大程度地治愈及减少复发的可能性。     

Ⅰ期切除缝合治疗骶尾部藏毛窦25例分析

目的探讨Ⅰ期切除缝合治疗骶尾部藏毛窦的手术方法及治疗效果。方法对25例骶尾部藏毛窦行Ⅰ期切除缝合手术治疗的临床资料进行回顾总结性分析。结果全组除1例术后5月复发外均治愈,无手术意外损失及严重并发症,住院时间12～16天,术后随访6月～1年,无窦道复发。结论Ⅰ期切除缝合治疗藏毛窦具有手术切除彻底、复发率低、愈合时间短、缩短住院周期的优点。     

直肠癌术中骶前静脉丛出血的预防和处理

目的　总结直肠癌根治手术中骶前静脉出血的预防和处理方法。方法　对 1 983年 6月～ 2 0 0 2年 6月我院完成的直肠癌根治术进行回顾性分析 ,发生术中骶前静脉出血病例 6例 ,行Miles术 5例 ,Dixon术 1例 ,术中失血量 <80 0ml 2例 ,80 0～ 2 5 0 0ml 3例 ,>2 5 0 0ml 1例 ,根据出血的部位及肿瘤情况采用图钉按压止血法以及纱布填塞压迫止血法止血。结果　止血后未再发生出血 ,无因出血而死亡病例 ,6例病人均痊愈出院。结论　肿瘤的浸润及手术操作不当是导致骶前静脉丛出血的主要原因 ,直肠癌根治手术中按骶前解剖层次正确操作是预防术中骶前静脉丛出血的关键 ,纱布条填塞压迫止血是处理骶前静脉丛出血行之有效的方法     

原发性骶前肿瘤的诊断与治疗

为探讨骶前肿瘤的诊断与治疗，分析了３７例骶前肿瘤的诊断和治疗情况。肿瘤直径３～１６ｃｍ。术前诊断主要依靠直肠指诊、Ｂ超、ＣＴ等相关检查。手术方法有：经骶尾部切除１５例，经腹切除１０例，经腹尾部联合入路切除６例。其中合并切除直肠４例，肿瘤完整切除２１例，部分切除１０例，未切除６例，切除率８３．８％。并发症有出血、直肠损伤、术后骶前感染、脓肿形成。作者认为合理选择手术径路、手术方式是切除肿瘤的关键。术前影像学检查对肿瘤定位和术式选择有重要意义     

原发性骶前肿瘤50例临床诊治分析

目的探讨原发性骶前肿瘤的诊断及外科治疗。方法回顾性分析徐州医学院附属医院普外科1980年1月至2012年7月期间收治的50例原发性骶前肿瘤患者的临床资料,并结合文献复习进行讨论。结果原发性骶前肿瘤的术前诊断主要依靠直肠指检、B超、CT、MRI等相关检查。手术采用经骶尾部入路22例,经下腹部正中入路22例,经腹、骶尾部联合入路6例。肿瘤被完整切除33例,行部分切除10例,未切除7例。并发症有术中出血、直肠损伤,术后切口感染、脓肿形成等。结论骶前肿瘤如无禁忌证均应行手术治疗。充分的术前评估、合理选择手术入路、多学科协作以及对术中和术后并发症的充分认识是手术成功的关键。     

Sacrococcygeal teratomas in infants and children

From 1941 through 1983, a total of 66 patients with sacrococcygeal teratoma were seen, representing 41 percent of the total of 162 patients with teratomas from all anatomic sites seen over this period. Forty-six (70 percent) of the patients with sacrococcygeal teratomas were female and 34 (52 percent) were neonates. Younger patients had a significantly better prognosis. Approximately half (48 percent) of the patients had benign tumors. Of the other 34 patients, 19 (29 percent) had frank malignancy, being either a purely malignant tumor or a tumor with malignant mixed with benign elements, and 15 (23 percent) patients had tumors containing embryonic but no malignant components. Patients with tumors containing mature adult or embryonic tissues have a good prognosis. However, malignant sacrococcygeal teratoma portends a bleak prognosis irrespective of therapy (in this series only one patient survived among 19 patients with an average survival of 16 months after diagnosis).     

骶前肿瘤手术27例临床分析

目的探讨骶前肿瘤的诊断及手术治疗方法及经验。方法骶前肿瘤患者27例,21例初发,6例为复发。均行肛指检查、CT和（／或）MRI作出诊断。肿瘤直径平均6．3（2．4～10．3）cm。单纯经腹手术2例,单纯经骶手术20例,经腹经骶联合手术5例。结果切口一期愈合21例。病理类型：皮样囊肿7例,表皮样囊肿6例,畸胎瘤4例（1例恶变）,平滑肌瘤3例,神经纤维瘤2例,脂肪瘤1例,感染形成脓肿3例,皮脂腺囊肿1例。所有患者均获随访,时间7～14个月。3例经骶手术复发,其中2例为皮样囊肿切除后引流不畅形成积液,再行手术切除引流治愈;1例畸胎瘤手术后复发,再行经骶切除后成功。1例感染形成的脓肿复发,经加强局部引流后愈合。结论骶前肿瘤诊断并不困难,CT等检查可指导手术方式。大多数肿瘤都可以采用经骶入路切除,手术后引流通畅是保障愈合的关键。     

经骶尾部入路的肛门直肠手术(附31例报告)

目的 介绍和评价经骶尾部入路的肛门直肠手术（Kraske手术）。方法 总结1995－2001年收治的31例经骶尾入路手术治疗的直肠良恶性疾病病例，并从术前准备、手术过程、并发症防治等方面进行分析。结果 良性病变9例，恶性肿瘤22例。手术过程顺利，切口均1期愈合，无肛门失禁病例。肿瘤病人随访1－6年，无死亡。结论 Kraske手术是处理肛门直肠疾病的一种显露良好、创伤合理、并发症相对较少的手术方法。     

经骶尾入路盆腔低位肿瘤切除术（附9例报告）

目的：探讨经骶尾入睡盆腔低位肿瘤切除的应用价值。方法：回顾性总结１９９５年５月至１９９９年１０月经手术及病理证实的盆腔肿瘤９例。其中，囊肿１例，畸胎瘤２例，脂肪瘤２例，脂肪肉瘤１例，神经纤维瘤２例，神经鞘瘤１例。结果：全部病例均经骶尾入路切创造，无任何并发症，切品无感染，Ⅰ期愈合。随访６月至４年，无一复发。结论：经骶尾入路盆腔低位肿瘤切除，手术创伤小，患者恢复快，并发症少，是肛肠外科较理想的手术方     

Sacral teratomas--organized forms

Between 1939 and 1971 31 cases of sacrococcygeal teratomas were observed at Zurich Children's Hospital, in 5 cases the tumor contained well-developed organs. From 1970 to 1982 25 cases of sacrococcygeal teratomas were identified at Teheran Children's Hospital. In 2 of these cases the tumors were organized. At the same time we observed 2 other cases, one a well differentiated retroperitoneal teratoma, the other an ectopic third leg in the lumbosacral region. In the so-called organized teratomas we found all organs with the exception of heart, lung, kidney, eyes and vertebra. Malignant degeneration was not observed. It is probable that such organized tumors develop from a concentration of rich pluripotent cells at the end of the coccyx. An explanation for ectopic extremities could be the deplacement of pluripotent cells at an early stage of embryonic development.     

Posterior surgical approaches to the rectum.

This report summarizes experience with 19 posterior approaches to the rectum including nine trans-sacral (Kraske) and ten trans-sphincteric (Mason) procedures. This study included 12 men and 7 women, ranging in age from 18 to 89 years. Surgical indications included villous tumors in nine patients, various benign problems in four patients, primary carcinomas in three patients, and recurrent cancer in three patients. Eight complications developed in the 19 patients including: four fecal fistulae, two wound dehiscences, one rectal stricture, and one sacrococcygeal hernia. Spontaneous closure of the fecal fistulae occurred in two patients, and two patients required proximal colostomies. Fecal continence was achieved in 18 of the 19 patients. No patient died as a complication of the procedure. No recurrent tumors have developed. The conclusion is that a posterior approach to the rectum is a safe and effective procedure for various benign and for selected malignant conditions. It is particularly suitable for villous tumors that are too high for transanal resection and too low for transabdominal resection. It is an effective procedure for small, exophytic, mobile carcinomas of the lower 10 cm of the rectum in selected patients.     

Clinical observations and the planning of therapy for sacrococcygeal tumors

Amongst sacrococcygeal tumors, teratoma is seen often while other histologic types are rare. It is apparent that the less obvious intrapelvic tumors can cause obstructive symptoms and are usually diagnosed late. Twenty cases of sacrococcygeal tumor, including 14 teratomas (9 benign, 5 malignant) and 6 others (3 benign, 3 malignant) were treated at Tokyo Medical College and Shizuoka Children's Hospital over the last 23 years. The majority of the benign tumors were readily excised, but one case of benign teratoma was difficult to excise and died of bleeding. The resectability of malignant tumors was low, but aggressive multiagent chemotherapy, radiotherapy and second look operation made it possible to increase the survival. One case is alive and has been disease free for 11 years. Recently combined therapy by chemotherapy and surgery has improved the survival rate although some problems still remain.     

Supratentorial primitive neuroectodermal tumors of the central nervous system in adults: molecular and histopathologic analysis of 12 cases

Advances in understanding the molecular basis of primitive neuroectodermal tumors of the central nervous system (CNS-PNET) biology are critical to improve patient outcome. Recently, new data on their molecular features have been reported, suggesting that supratentorial PNET (s-PNET) in adult patients may represent a specific tumor entity among CNS-PNETs. In this study, we analyzed the clinicopathologic and molecular features of 12 cases of s-PNET in adult patients. The follow-up analysis showed that these tumors have an aggressive clinical behavior. At the histopathologic level, they resembled their pediatric counterpart, showing a variable spectrum of neuronal differentiation. These cases did not show astrocytic differentiation; therefore, they did not qualify for the differential diagnosis of glioblastoma variants. The tumors were also screened for mutation of TP53, IDH1, IDH2, and β-catenin, using single strand conformation polymorphism-based and sequencing assays, and were analyzed for c-myc/N-myc gene copy numbers with a quantitative polymerase chain reaction-based method. The strand conformation polymorphism-based mutational analysis showed that 5 tumors harbored TP53 mutations. In 2 cases, a mutation at codon 132 of the IDH1 gene was also found. No mutations of the β-catenin or IDH2 genes were identified. No cases presented c-myc or N-myc amplifications. Only 1 case presented overexpression of epidermal growth factor receptor. In conclusion, our data show a high incidence of TP53 mutations in this group of tumors and show, in comparison with pediatric s-PNET, the absence of amplification of the c-myc/N-myc genes, indicating that s-PNET in adult patients may represent a specific subset of tumors among CNS-PNETs.     

腹腔镜联合胃镜治疗胃间质瘤45例

目的探讨腹腔镜与胃镜联合在切除胃间质瘤中的应用价值。方法回顾性分析我院2008年6月至2012年6月期间行腹腔镜联合胃镜治疗的45例胃间质瘤患者的临床资料。结果 45例患者均在腹腔镜与胃镜结合下成功切除胃间质瘤,肿瘤切除完整,边缘无残留。手术切口长约4～6cm（平均5.1cm）,手术时间40～90min（平均75min）,术后恢复顺利,未发生手术相关并发症,住院时间5～9d（平均6.8d）。随访3～24个月（平均16.5个月）,未发生复发或转移。免疫组织化学检测结果：CD117阳性43例,CD34阳性32例,SMA阳性28例,Desmin阳性2例,S-100阳性22例。结论腹腔镜与胃镜结合治疗胃间质瘤,具有创伤小、手术时间短、术后恢复快等优点,同时由于有胃镜配合可以使切除范围更加精确,避免肿瘤残留及切除过多正常胃组织。     

多学科合作外科处理头颈部复杂肿瘤

目的：探讨多学科合作外科处理头颈部复杂肿瘤的经验,以提高临床治疗效果。方法：回顾分析1995年4月－2000年6月与神经外科等其他学科合作,外科治疗头颈肿瘤累及颅底,颅内或颈椎管内等相邻部位结构的22例患者临床资料。结果：本组良性肿瘤患者14例,获得肿瘤全切除;恶性肿瘤8例,5例达到肉眼全切除,3例得到减状治疗,无手术死亡和严重并发症病例,良性肿瘤患者平均随诊3例,肿瘤复发率为21．4％（3／14）,均为外院术后再治疗,8例恶性肿瘤患者随诊1年,3例无复发,2例带瘤生存,3例死亡。结论：对于复杂的头颈部肿瘤的外科治疗,应提倡多学科间的密切合作,可明显提高患者的治疗效果。