2140例骨肿瘤及瘤样病变统计分析

目的 探讨骨肿瘤及瘤样病变在我区的发病情况。方法 统计我院1963～2000年经病理检查证实的2140例骨肿瘤及瘤样病变进行统计分析。结果 原发性良性肿瘤583例(27．24％)，骨巨细胞瘤480例(22．43％)，原发恶性骨肿瘤590例(27．57％)，转移瘤33l例(15．47％)，瘤样病变156例(7．29％)。原发良、恶性肿瘤之比为0．99：1，男女之比为1．53：1，好发年龄为11～30岁，好发部位为股骨(30．18％)，其次为胫骨(20．40％)，良性骨肿瘤以骨软骨瘤(36．71％)、骨瘤(14．92％)多见。恶性骨肿瘤以骨肉瘤(53．56％)，软骨肉瘤89例(15．08％)多见。瘤样病变则以骨囊肿(66．03％)、骨纤维异样增殖症(28．21％)多见。结论 本组结果与国内文献对比有较多相似之处，但良、恶性骨肿瘤之比有较大不同，这可能与广西少数民族生活习惯及骨巨细胞瘤另分组统计有关。     

1355例骨肿瘤和瘤样病变的统计分析

A total of 1355 cases of tumors and tumor-like lesions in the bone seen in the three hospitals affiliated to our college in the past 32 years was analysed. Of them, 1170 (86.4%) were primary bone tumors, 31 (2.3%) metastatic and 154 (11.3%) tumor-like lesions of bone. Histologically, the primary bone tumors were mostly chondrogenic and osteogenic. The ratio of benign to malignant tumors was 2.8:1. Peak ages were 11-40 years. Patients with malignant tumors were ten years younger than those with benign tumors. The first three common benign bone tumors were osteochondroma, osteoma and chondroma. The vulnerable sites were tibia, femur and skull. The first three common malignant bone tumors were osteosarcoma, chondrosarcoma and fibrosarcoma with common sites in femur, tibia and humerus. The majority of tumor-like lesions were fibrous-dysplasia, frequently in the femur. These observations are very similar to those reported at home but quite different from those reported from other countries. In our series, the ratio of benign to malignant bone tumors was the highest (2.8:1); giant cell tumor was not among the first three common benign bone tumors; and the first vulnerable site of benign bone tumors was not femur but tibia.     

Malignancy in giant cell tumor of bone

BACKGROUND: The term malignant giant cell tumor embraces multiple entities and therefore can be confusing. The goals of the current study were to define the clinicopathologic and histologic features of malignancy in giant cell tumors and to clarify the terminology. METHODS: The authors reviewed all cases from the Rizzoli Institute (Bologna, Italy) of primary (PMGCT) and secondary (SMGCT) malignancy in giant cell tumors. PMGCT is a high-grade sarcoma that arises side by side with benign giant cell tumors. SMGCT is a high-grade sarcoma that occurs at the sites of previously treated giant cell tumors of bone. RESULTS: The authors report 5 PMGCTs and 12 SMGCTs; half of the SMGCTs were postradiation sarcomas. Patient age ranged from 20 to 68 years (median, 62 years) for PMGCT and from 30 to 77 years (median, 40 years) for SMGCT. The average latent period between diagnosis of giant cell tumor and diagnosis of SMGCT was 9 years (range, 3-15 years) for patients with postradiation SMGCT and 19 years (range, 7-28 years) for patients with SMGCT resulting from spontaneous transformation. The histologic classification of high-grade sarcomas in the PMGCT group was osteosarcoma in four cases and malignant fibrous histiocytoma in one case. In the SMGCT group, the histologic classification was osteosarcoma in nine cases, fibrosarcoma in two cases, and malignant fibrous histiocytoma in one case. The outcomes associated with all malignancies in giant cell tumors were poor, with the worst outcome associated with postradiation SMGCT. CONCLUSIONS: Malignancies in giant cell tumors of bone always are high-grade sarcomas with a poor prognosis. These lesions must be distinguished from benign giant cell tumors of bone. SMGCT usually is easy to diagnose upon malignant clinicoradiographic presentation. In contrast, PMGCT often mimics giant cell tumors both clinically and radiographically. In addition, upon histologic examination, PMGCT shows areas of conventional giant cell tumor, which can lead to difficulties in making the correct diagnosis.     

3409例骨关节肿瘤与瘤样病变统计分析

目的分析总结临床常见骨关节肿瘤的流行病学发病情况及构成比。方法通过对西京骨科医院骨肿瘤科1990—2007年18年收住的原发性良、恶性骨关节肿瘤、骨瘤样病变、骨转移瘤3409例的统计分析,观察临床各种常见骨关节肿瘤的构成比及其在不同年龄、性别及部位的发病情况。结果3409例骨关节肿瘤中良恶性肿瘤之比为1．12：1;良性肿瘤与恶性肿瘤男女性别比为1．28：1与1．29：1;年龄组中最好发于10．20、20。30岁,病变部位最好发于股骨和胫骨;发病率从高到低依次为：骨肉瘤、骨巨细胞瘤、骨软骨瘤、骨纤维结构不良和骨囊肿。其中恶性肿瘤最常见的是骨肉瘤,其次为软骨肉瘤和恶性纤维组织细胞瘤,恶性肿瘤的好发部位为胫骨和股骨;良性肿瘤最常见的为骨巨细胞瘤,其次为骨软骨瘤,良性肿瘤的好发部位为胫骨和股骨。骨瘤样病变最常见的是骨纤维结构不良,其次为骨囊肿;骨转移瘤最常见的部位是脊柱。结论本组统计和国内其他地区统计基本相同,与国外报道有一定差异。     

640例脊柱肿瘤及瘤样病变的临床流行病学分析

目的 总结临床常见脊柱肿瘤及瘤样病变的流行病学发病情况及构成比。方法 通过对西京骨科医院骨肿瘤科和铜川市人民医院骨科1990年至2007年收治的640例脊柱肿瘤及瘤样病变患者资料进行统计学分析,观察临床各种常见脊柱肿瘤的构成比及其在不同年龄、性别及部位的发病情况。结果 640例脊柱肿瘤及瘤样病变中良恶性之比为062∶1;良性与恶性肿瘤男女性别比为1.11∶1与0.77∶1;年龄分组中良性肿瘤好发于31～40岁和41～50岁,恶性肿瘤及转移瘤好发于51～60岁和＞60岁;发病率从高到低依次为：转移瘤、神经鞘瘤、脊索瘤、骨髓瘤、骨巨细胞瘤、神经纤维瘤,其中脊柱恶性肿瘤最常见的是转移瘤,原发恶性肿瘤中最常见为脊索瘤,其次为骨髓瘤。良性肿瘤最常见为神经鞘瘤,其次为骨巨细胞瘤;良性肿瘤的好发部位为腰椎,恶性肿瘤的好发部位为骶椎和腰椎,转移瘤好发部位为胸椎。结论 在脊柱肿瘤及瘤样病变中,以恶性多见,尤其是转移瘤高发;男女性别无明显差异;转移瘤好发于60岁以上患者。     

骨与关节肿瘤及瘤样病变2317例统计分析

目的统计分析桂林地区骨与关节肿瘤及瘤样病变的发病情况。方法本协作组1987年～2007年先后3次对桂林地区近30家各级医院骨与关节肿瘤及瘤样病变病例进行统计。结果总计2317例，良性骨肿瘤947例（40．87％），骨巨细胞瘤135例（5．83％），原发恶性骨肿瘤470例（20．28％），骨转移瘤484例（20．89％），骨瘤样病变175例（7．55％），关节与滑膜肿瘤及瘤样病变106例（4．57％）。良性骨肿瘤以骨软骨瘤最多见为（551例，58．18％），骨瘤（14．15％）与软骨瘤（13．83％）次之。原发恶性骨肿瘤以骨肉瘤（183例，38．94％）与骨髓瘤（175例，37．23％）多见，软骨肉瘤（6．4％）次之。骨瘤样病变以骨纤维异样增殖症（70例，40％）与骨囊肿（66例，37．71％）多见。多种骨肿瘤患者男性多于女性，好发年龄11～30岁，好发部位与股骨与胫骨。结论桂林地区骨与关节肿瘤及瘤样病变发病统计结果与国内外文献报道结果相似，少数病种相对多与收集范围有关。     

Primary bone tumors and pseudotumors of the lumbosacral spine

Primary tumors of the spine are relatively infrequent lesions compared with metastatic disease, multiple myeloma, and lymphoma which are the more frequent neoplasms of the spine and usually manifest with multifocal lesions and thus pose little diagnostic dilemma. However, in the presence of a solitary spinal lesion, the more uncommon primary tumors of the spine represent an important group of entities for diagnostic consideration. The most common benign and malignant primary tumors of the spine are enostosis, osteoid osteoma, osteoblastoma, giant cell tumor, aneurysmal bone cyst, osteochondroma, chordoma, chondrosarcoma, Ewing sarcoma, primitive neuroectodermal tumor, and osteosarcoma. The imaging features of these lesions are often characteristic. Radiologists should be aware of the appearance of these unusual tumors in order to provide a complete differential diagnosis.     

膝部肿瘤切除后关节功能重建的方法分析

目的 探讨膝部肿瘤切除后关节功能重建的方法选择和疗效。方法 54例膝关节周围肿瘤中，骨巨细胞瘤25例，非骨化性纤维瘤2例，成纤维性纤维瘤2例，动脉瘤样骨囊肿1例，软骨黏液性纤维瘤2例，骨肉瘤15例，软骨肉瘤2例，恶性纤维组织细胞瘤5例。23例采用瘤体切除，吻合血管的自体髂骨、腓骨联合移植术，12例瘤段切除灭活再植术，19例瘤段切除人工假体置换术。结果 54例平均随访5年6个月，成活病例术后功能评价优良率为76％。结论 膝部肿瘤切除后关节功能的重建，应根据肿瘤的大小、包壳的完整性、软组织的侵及情况，以及肿瘤的病理组织学性质，选择适当的手术方法。瘤体切除，吻合血管的自体髂骨、腓骨联合移植术，是治疗膝关节周围良性侵袭性肿瘤或低度恶性肿瘤较为理想的方法。     

葡萄糖转运蛋白-1在不同骨肿瘤中的表达

目的研究葡萄糖转运蛋白-1（GLUT-1）在正常骨组织及不同骨肿瘤标本中的表达情况。方法收集我院临床骨肉瘤标本30例，骨巨细胞瘤标本15例，骨样骨瘤标本10例及正常骨组织标本10例，采用免疫组化染色检测GLUT-1的分布。体外培养骨肉瘤细胞系MG63、临床骨肉瘤细胞、临床骨巨细胞瘤细胞及成骨细胞，RT-PCR检测GLUT-1基因的表达。结果免疫组化显示，骨肉瘤标本GLUT-1染色强阳性占总例数的53％；骨巨细胞瘤切片GLUT-1染色，阳性占总例数的60％；骨样骨瘤标本多为阴性，阴性占总例数的80％；正常骨组织中未见GLUT-1阳性表达。骨肉瘤明显高于与其余3组标本（χ^2=1．622，P=0．009；χ^2=34．667，P〈0．001，χ^2=40．000，P〈0．001）。RT-PCR显示，GLUT-1基因表达存在于MG63细胞、临床骨肉瘤细胞及骨巨细胞瘤中，而正常成骨细胞内并无GLUT-1表达。结论骨肿瘤中存在GLUT-1表达，且GLUT—1与骨肿瘤的恶性程度有较密切的关系。GLUT-1有可能作为判断骨肿瘤恶性程度参考指标及骨肿瘤治疗的新靶点。     

单椎体116例良恶性骨肿瘤临床及影像学分析

目的:分析单椎体骨肿瘤的临床特征及影像学表现,以提高对单椎体骨肿瘤的认知及疾病诊断水平。 方法:回顾2011年1月至2017年9月本院收治的资料完整的116例单椎体骨肿瘤。总结分析患者的性别、年龄、病理类型及影像学表现。两名放射科诊断医师分别对DR、CT、MRI诊断骨肿瘤的价值进行评价。结果:原发肿瘤93例,转移瘤23例。男62例,女54例,年龄8～75岁,平均（48.6±8.3）岁。良性骨肿瘤23例,占19.83%;中间型骨肿瘤21例,占18.10%;恶性骨肿瘤72例,占62.07%。良性骨肿瘤平均发病年龄32（11～60）岁,常见病种有骨软骨瘤、纤维结构不良;中间型骨肿瘤平均发病年龄36（20～64）岁,常见病种有骨巨细胞瘤、侵袭性血管瘤;恶性骨肿瘤平均发病年龄59（37～76）岁,常见病种有转移瘤、孤立性浆细胞瘤。CT和MRI骨肿瘤的诊断符合率均高于DR(P＜0.05),CT和MRI的诊断符合率差异没有统计学意义(P＞0.05)。结论:单椎体骨肿瘤恶性多见,以转移瘤、孤立性浆细胞瘤为主。CT和MRI单椎体骨肿瘤诊断价值优于DR。     

鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤,4例经鼻腔和鼻外切口双径路手术治疗,其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻,经治疗后好转;1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤,术后出现患侧内眦外移;4例良性骨源性病变患者行鼻内镜下病变部分切除术,其余病例均彻底切除肿瘤而无明显并发症,随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势,在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。     

68例骨肿瘤致病理性骨折的治疗

目的:研究不同的外科治疗方法对骨肿瘤病理性骨折患者预后的影响.方法:自1995年6月～2002年10月共收治68例病理性骨折.引起病理性骨折的肿瘤中,转移癌27例(转移至四肢17例,脊柱8例,锁骨2例).原发恶性肿瘤20例(骨肉瘤13例,尤文氏肉瘤3例,软骨肉瘤2例,恶性纤维组织细胞瘤2例).良性肿瘤21例(骨巨细胞瘤12例,骨囊肿4例,内生软骨瘤及动脉瘤样骨囊肿各2例,纤维异样增殖症1例).通过回顾性分析研究,对其临床表现、诊断、治疗进行初步临床分析.结果:随访6个月～7.2年,转移癌中7例行局部广泛切除,假体置换,未见局部复发,功能良好.8例行病灶刮除,髓内针内固定,其中4例死亡,3例局部复发.13例骨肉瘤患者,9例对化疗敏感,行保肢手术,术后未见局部复发,预后良好,4例对化疗不敏感,行截肢术,术后均有肺转移.12例骨巨细胞瘤,7例行肿瘤广泛切除,假体置换,术后随访未见局部复发.5例行病灶刮除,骨水泥填充,其中3例复发.结论:对于转移癌、骨巨细胞瘤和一些良性肿瘤所致的病理性骨折,肿瘤的彻底切除和假体置换对于控制局部复发是有效的,并可获得良好的功能.对化疗敏感的骨肉瘤患者,即使骨折,经过化疗和适当处理后,也可行肿瘤的彻底切除和假体置换,也可获得良好的局部控制和降低肺转移发生率.     

Pathological studies on epidermic and appendage tumors and tumor-like lesions--analysis of 3,425 cases

This paper analyses 3,425 cases of epidermic and appendage tumors and tumor-like lesions. There were 2,137 cases (62.4%) of benign tumors and tumor-like lesions and 1,288 (37.6%) of malignant tumors. The incidence of benign tumors and tumor-like lesions in the epidermis (1,742 cases, 81.5%) was higher than that in the appendage (395 cases, 18.5%). The most common malignant tumor was squamous cell carcinoma (958, 74.4%) and the basal cell carcinoma (296, 23.0%) ranked second, while the malignant tumor in the appendage was very rare (34, 2.6%). The ratio of squamous cell carcinoma and basal cell carcinoma was 3.2:1. For the sex difference in general, male was slightly common than the female (1.5:1 in the benign tumors and 2.1:1 in the malignant), but in basal cell carcinoma and benign tumors of the hair follicle and sweat glands, there were more female than the male. For the age difference, the incidence of the benign tumor and tumor-like lesion were higher in the adolescence and adult, while the malignant tumors, were more prevalent in the adult and the elderly. The basal cell carcinoma was frequently seen in the old ages. For the site difference, most cases of skin tumors were located in the head and neck, but more than half of squamous cell carcinomas occurred in the penis.     

妇科恶性肿瘤患者心理状况及相关因素分析

目的:研究妇科恶性肿瘤患者的社会心理特点和心身健康状况.方法:采用临床心理评定量表中的生活事件量表(LES)和90项心理症状核查表(SCL-90),对60例妇科恶性肿瘤患者遭遇的生活事件和心身健康状况进行问卷调查,与同期住院的良性肿瘤者和健康者各40例相比较.结果:1)恶性肿瘤组病前遭遇到的生活事件总频数及紧张值、负性生活事件的频数及紧张值均高于良性肿瘤组和健康对照组,差异有显著性(P<0.05),正性生活事件频数及紧张值无显著性变化.良性肿瘤组与健康对照组比较,生活事件总频数及负性事件频数高于健康对照组,差异有显著性(P<0.05),正性事件频数、精神紧张总值及正性精神紧张值,两组比较,差异无显著性.2)恶性肿瘤组SCL-90各项指标,阳性项目均分及其他因子分与健康对照组、良性肿瘤组无差异(P>0.05),躯体化、强迫、人际关系敏感、焦虑、敌对、恐怖、偏执、精神病性等均高于健康对照组和良性对照组,差异有显著性(P<0.05).良性肿瘤组阳性项目均分及抑郁分高于健康对照组,差异有显著性(P<0.05),躯体化、强迫、人际关系敏感、焦虑、敌对、恐怖、偏执、精神病性与其他因子分等与健康对照组比较,差异无显著性(P>0.05).结论:不良心理社会因素与妇科恶性肿瘤的发生密切相关,对妇科肿瘤患者应采取积极的社会心理干预措施.     

Clinical analysis of salivary gland tumor cases in West China in past 50 years

In our study, 3461 cases of salivary gland tumor treated between 1955 and 2002 at West China Stomatology Hospital of Sichuan University were retrospectively analyzed, and compared with the previous reports. Measures such as age, tumor location, tumor histological type, and the nature of the growth (benign or malignant) were recorded at the same time. The findings are as follows: the average ages of salivary gland tumor patients were 41.38 years for the benign cases and 45.20 for the malignant ones; the male:female ratio was 0. 99:1 in the benign cases and 1.34:1 in the malignant ones; primary tumors were mostly in the parotid gland, palate and submandibular gland in sequence. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor and basal cell adenoma, whereas mucoepidermoid carcinoma, adenoid cystic carcinoma and adenocarcinoma not otherwise specified were the most frequent malignant tumors. The incidence of salivary gland tumors increased with age. The male:female ratio of malignant tumors was higher than that of benign ones. The parotid gland and palate were the most common locations of salivary gland tumors. Pleomorphic adenoma and mucoepidermoid carcinoma were the most frequent benign and malignant tumors, respectively.     

1513例骨肿瘤及肿瘤样病变统计分析

 本文统计分析了骨肿瘤及肿瘤样病变1513例。其中良性骨肿瘤907例,占59.95%;恶性骨肿瘤450例,占29.74%;肿瘤样病变156例,占10.31%。三组病例都好发于11—40岁,男性较女性多见,为2。28:1。好发部位较多见于股骨、胫骨和肱骨,不同病变有不同的好发部位。良性骨肿瘤中以骨软骨瘤最多见,其次为骨巨细胞瘤。恶性骨肿瘤中以骨肉瘤最多见,其余依次为软骨肉瘤、转移癌、尤文氏瘤、骨髓瘤、骨纤维肉瘤、巨细胞瘤、脊索瘤、皮质旁骨肉瘤、网织细胞肉瘤。骨的肿瘤样病变包括嗜伊红性肉芽肿、骨纤维异常增殖症,弧立性骨囊肿和动脉瘤样骨囊肿。     

病灶刮除后不同填充方式治疗膝周骨巨细胞瘤的临床回顾分析

目的探讨不同填充物在局部刮除病灶后对于膝周骨巨细胞瘤(GCT)的治疗效果。方法回顾性分析2002年3月至2018年12月四川省肿瘤医院骨软组织外科收治的具有完整临床病理及随访资料的46例经病理确诊并接受手术治疗的膝周GCT,按照病灶刮除后填充物的不同分为自体骨组、异体骨组和骨水泥组。收集患者一般资料(包括性别、年龄和GCT发生部位等)、临床资料(包括术中输血、手术时间及住院时间等)和随访数据(包括肿瘤复发和MSTS评分),分析病灶刮除后不同填充方式和Campanacci分期等因素与肿瘤复发的关系。结果GCT患者术中输血和手术用时以骨水泥组最少,异体骨组次之,自体骨组最多;排异反应发生率以异体骨组最高,自体骨组和骨水泥组均为0,但差异无统计学意义(P>005)。平均住院日以异体骨组最长,自体骨组次之,骨水泥组最短,差异有统计学意义(P<005)。术后总体MSTS评分33例为优,8例为良,5例为中,MSTS评分与不同填充方式无关;术后复发6例,复发率1304％,不同填充方式间复发率分别为自体骨组1364％、异体骨组1176％、骨水泥组1428％,不同填充方式间复发率差别无统计学意义(P>005)。结论对于不同Campanacci分期和Enneking分期的膝周GCT选择病灶刮除灭活并填充的手术方式均可以完好地保留患者膝关节功能同时不会增加肿瘤复发率。相比于自体骨和异体骨填充,使用骨水泥可以降低患者手术用时及出血风险,缩短住院时长,且不会导致排异反应。     

乳腺复发性叶状肿瘤临床病理分析

目的:探讨乳腺复发性叶状肿瘤临床及病理特征。方法:收集2011年01月至2019年12月在我院进行手术治疗的叶状肿瘤病例,并找出其中复发的病例,分析复发病例的临床及病理组织学特征。结果:叶状肿瘤137例,共有10例为复发病例,其中9例为单次复发,1例复发两次,复发病例中良性叶状肿瘤7例,交界性叶状肿瘤2例,恶性叶状肿瘤1例。所有的肿物均为局部复发,良性、交界及恶性叶状肿瘤复发率分别为5.9%、15.4%、20%。其中3例（30%）出现组织学升级,1例良性叶状肿瘤复发为交界性叶状肿瘤,1例交界性叶状肿瘤复发为恶性叶状肿瘤,1例良性叶状肿瘤第一次复发为交界性叶状肿瘤,第二次复发为恶性叶状肿瘤。免疫组化标记CD117、CD34、CD10、p53、p16在原发及复发肿瘤中表达无差异。Ki67增殖指数在复发病例中均升高,并且核分裂数也增多。结论:良性、交界性、恶性叶状肿瘤均可复发,其中恶性叶状肿瘤复发率最高,肿瘤多为局部复发,部分肿瘤复发后出现组织学升级,复发后肿瘤细胞增殖活性增强。     

骨盆良性肿瘤201例流行病学分析

目的：分析骨盆良性肿瘤的流行病学特征及影像学特点,提高对骨盆良性肿瘤的认识及疾病的诊断水平。方法回顾北京积水潭医院肿瘤科1958年7月至2011年10月收治的201例骨盆良性肿瘤患者资料,记录患者的年龄、性别,分析骨盆肿瘤的好发年龄、性别比例;回顾病理资料,确定肿瘤的病理类型;影像资料由两位高年资骨肿瘤专科医生阅片,确定肿瘤的解剖部位、影像学特点;综合上述资料按性别、年龄、肿瘤类型、发生部位、影像学特点进行统计,分析各骨盆良性肿瘤的流行病学特点。结果男114例,女87例,男∶女为1.31∶1;发病年龄5～72岁,中位年龄28.0岁,平均30.1岁。20岁以下病例58例（28.86%）,21～30岁52例（25.87%）,31～40岁54例（26.87%）,41～50岁21例（10.45%）,50岁以上16例（7.96%）。较多见的有骨巨细胞瘤59例,骨软骨瘤53例,单纯性骨囊肿17例,动脉瘤样骨囊肿15例,骨纤维结构不良14例,软骨母细胞瘤13例。髋臼周围为肿瘤好发部位,骨巨细胞瘤及动脉瘤样骨囊肿具有较强侵袭性,易累及多个分区。结论骨盆良性肿瘤好发于40岁以下人群,好发于髋臼周围。综合流行病学情况及影像学研究有利于疾病的早期诊断和鉴别诊断。     

骶尾部肿瘤手术治疗的中远期评价

目的 评价骶尾部肿瘤手术治疗的中远期效果.方法 回顾分析1993年4月至2010年2月收治的47例骶尾部肿瘤患者,其中包括脊索瘤13例,囊肿6例,骨巨细胞瘤4例,脂肪瘤3例,皮脂腺瘤3例,软骨肉瘤3例,恶性源性肿瘤3例,转移癌3例,纤维瘤2例,畸胎瘤2例,神经纤维瘤、纤维脂肪错构瘤、神经节细胞瘤、良性间叶瘤、低度恶性纤维母细胞瘤、孤立性纤维瘤、恶性神经鞘瘤各1例.术前主要临床症状：骶尾区疼痛37例,臀部及大腿麻痛33例,大小便障碍5例,双侧下肢肿胀、难以入睡1例.术前行选择性瘤血管栓塞术15例.6例行前后路联合手术,41例行后路手术.良性肿瘤全部为瘤外切除,恶性肿瘤为瘤内切除.结果 术中出血量500～5000ml,平均3000ml,术前行选择性瘤血管栓塞者术中平均出血量为1300ml.13例失访,余34例患者获得随访2-11年,平均随访时间6.4年.8例脊索瘤术后均反复出现局部复发,最快者为术后1个月复发,因其他脏器发生转移而死亡;4例骨巨细胞瘤3例失访,1例随访3年下肢功能、感觉活动良好,无大小便障碍.3例软骨肉瘤术后1例出现复发后死亡,2例无瘤生存;2例转移性癌和3例恶性源性肿瘤术后均死亡.全部良性肿瘤预后较好.结论 骶尾部肿瘤发病率较低,起病隐匿、症状轻微者占多数.术前行选择性瘤血管栓塞能够有效降低术中出血的风险.良性肿瘤可进行边缘完整的切除,预后良好;而单纯手术治疗对骶尾部恶性肿瘤来讲,复发率高,预后差,采用全骶骨切除或手术联合放化疗可望降低术后复发率,改善预后.