保留对侧骶神经孔的部分骶骨及骶髂关节整块切除术

 目的 探讨累及部分骶骨及一侧骶髂关节的骶骨恶性肿瘤采用保留对侧神经孔、纵行半侧或超半侧骶骨整块切除的手术入路及切除方式。方法 2005年2月至2010年7月间,共有16例累及部分骶骨及一侧骶髂关节的骶骨恶性肿瘤患者接受矢状位纵行半侧或超半侧骶骨(保留对侧骶神经孔)肿瘤整块切除及功能重建手术。男10例,女6例;年龄17~70岁,平均37.9岁。软骨肉瘤5例、Ewing肉瘤3例、恶性神经鞘瘤2例、骨肉瘤2例、恶性骨巨细胞瘤1例、淋巴瘤1例、转移瘤2例。结果手术时间4.0~11.5 h,平均6.5h;术中出血量1500~5500 ml,平均3600 ml 。5例患者为Ⅰ型切除,11例患者为Ⅱ型切除。随访时间21~59个月,平均34.4个月。术后3个月进行功能评估,除3例患者保留患侧S1神经根者外,其余13例均出现患侧足踝跖屈功能障碍。所有16例患者均不同程度地保留了括约肌功能。无围手术期死亡患者。4例(25%)术后出现切口并发症,经手术清创、引流后愈合。7例(43.8%)出现局部复发,6例病灶内手术者中5例局部复发,4例为骶骨侧复发,1例为软组织复发。8例(50.0%)无瘤生存,2例(12.5%)患者带瘤生存,6例(37.5%)患者死于肿瘤。结论 保留对侧神经孔、纵行半侧或超半侧骶骨整块切除具有可操作性,相对于全骶骨切除有着较好的功能学结果。     

计算机辅助导航技术在骶骨肿瘤外科治疗中的应用

目的 评估计算机辅助导航技术在术中指引骶骨肿瘤的骨性边界精确外科切除中的意义.方法 2007年12月至2010年6月,对13例骶骨肿瘤患者实施计算机辅助导航的外科治疗,男5例,女8例;年龄21～69岁,平均44岁;肿瘤位于骶S3水平以上10例,S3水平以下3例.术前行穿刺活检或前次手术明确病理诊断,脊索瘤7例,骨巨细胞...     

骨盆原发恶性Ⅳ型肿瘤的骶骨侧外科分型

 目的 评估累及骶骨的骨盆原发恶性肿瘤骶骨侧外科分型及其在外科边界获得、围手术期风险控制、肿瘤学和功能学改善中的作用。方法 2003年2月至2013年2月,采用手术治疗累及骶骨的骨盆原发恶性肿瘤（修订的Enneking Ⅳ型肿瘤）患者59例。男28例,女31例;年龄15~72岁,平均36岁。根据累及的骶骨范围不同将骨盆Ⅳ型肿瘤分为Ⅳa、Ⅳb、IVc、Ⅳd四个亚型,Ⅳa型43例,Ⅳb型9例,Ⅳc型5例,IVd型2例。不同的亚型采取相应的规范化肿瘤切除与重建方法。结果 外科边界满意43例（73%,43/59）,边界不满意16例（27%,16/59）。手术时间2.5~13 h,平均5.0 h;术中出血500~6 000 ml,平均2 157 ml。没有因围手术期并发症而死亡的病例。53例患者获得随访,随访时间6~88个月,平均26个月。20例（38%,20/53）于术后1~52个月出现局部复发,平均复发时间12个月。10例（19%,10/53）出现转移,20例（38%）在末次随访时仍无瘤生存。美国骨与软组织肿瘤协会（Musculoskeletal Tumor Society,MSTS）93评分平均58.1%,其中Ⅳa型平均57%（10%~100%）,Ⅳb型平均66%（13%~100%）,Ⅳc型平均45%（13%~77%）,Ⅳd型平均30%（26%~33%）。结论 对Enneking Ⅳ区肿瘤根据累及骶骨范围不同进行的亚分型,为手术入路和切除范围提供了依据。根据不同亚型进行手术切除与重建,能够获得良好的外科边界、肿瘤学预后及术后功能,降低手术风险。     

原发性骶骨肿瘤的外科治疗

１９８５年至今，作者对２４例原发性骶骨肿瘤实施了手术治疗，其中骶骨大部切除７例；扩大范围半骨盆切除３例；肿瘤刮切术１４例。随访１～６年，６例恶性肿瘤死于远隔部位转移，１例脊索瘤软组织复发．本文介绍了骶骨肿瘤的诊断、手术方法及预后等。特别介绍了腹－腹股沟切口及前后联合入路在骶骨手术中的用途。作者认为：腹－腹股沟切口较常规下腹直切口显露盆骶部结构更清楚；前后同时入路显露肿瘤的方法具有出血少、保护重要神经、显露清楚等优点。     

原发性骶骨肿瘤的手术治疗

目的 总结原发性骶骨肿瘤手术治疗的体会。方法 回顾性分析1993年9月～2004年12月手术治疗骶骨肿瘤患者21例。肿瘤位于S3以上者9例;S3以下者12例。本组行全骶骨切除和次全骶骨切除9例,骶骨部分切除12例。并就其外科治疗的手术方法选择、并发症防治以及决定手术成败关键问题的处理进行探讨。结果 全部手术无一例死于术中。术后近期并发症2例为切口皮缘坏死;3例皮下血肿;2例脑脊液漏,2例局部浅表感染。随访18例,随访时间最长9年,最短13个月,平均2．6年,1例死于慢性感染,3例死于肿瘤复发和转移,14例能从事一般工作。结论 术前详细地了解肿瘤的性质、侵犯的部位和范围对手术方案的设计具有重要意义;而减少术中出血、保留马尾神经功能以及重建高位骶骨肿瘤术后骨盆负重功能则是决定手术成败的关键。     

髋臼周围肿瘤切除股骨头旷置术

目的 探讨股骨头旷置术治疗髋臼周围肿瘤的可行性.方法 1999年10月至2009年8月采用髋臼肿瘤切除股骨头旷置术治疗累及髋臼的Enneking Ⅱ区肿瘤患者18例,男16例,女2例;年龄18～72岁,平均54岁.软骨肉瘤4例,骨肉瘤2例,骨巨细胞瘤4例,滑膜肉瘤1例,恶性纤维组织细胞瘤1例,Ewing肉瘤1例,转移瘤5例.3例行术前选择性动脉栓塞,4例行麻醉后腹主动脉或髂总动脉球囊临时阻断.术后门诊随访观察关节功能及影像学变化.结果 全部病例随访3～118个月,平均55个月.手术时间120～350min,平均170min.出血量600～2200ml,平均1200ml.切口均愈合,无一例发生伤口感染.1例骨肉瘤、3例转移癌患者于术后6个月至2年死于多脏器转移,其余病例无肿瘤局部复发.肢体不等长2.0～7.5 cm,平均5.0 cm,所有患者均需足跟垫高2～3 cm的矫形鞋进行矫正.术后3个月Enneking评分20～27分,平均23分.影像学资料提示,至随访期末无股骨头坏死发生,8例假臼磨造较好,1例发生轻度腰椎侧凸.结论 对于累及髋臼的Enneking Ⅱ区肿瘤采用肿瘤切除股骨头矿置术术后并发症发生率低,近期功能良好,肿瘤复发率低.

Abstract：

Objective To study clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum with less limb damage and complications.Methods From October 1999 to August 2009,18 patients with pelvic tumors around acetabalum (zone Ⅱ of Ennekingl were treated with tumor resection and femoral head exclusion,including 16 males and 2 females with an average age of 54 years(range,18-72).The diagnosis were chondrosarcoma(4 cases),osteosarcoma(2),giant cell tumor of bone(4),synoviosareoma(1),malignant fibrous histiocytoma(1),Ewing sarcoma(1),and metastatic carcinoma(5).Throe cases were treated by selective arterial embolization before operation and 4 cases by temporary block of lower abdominal aorta or common iliac arte.Regular follow-up in clinic was done to observe function of joint and radiographic imaging.Results All patients were followed up for 55 months(range,3-118).The mean surgical time was 170 min(range,120-350 min).The mean blood loss was 1200 ml(range,600-2200 ml).All wounds were healed without infection.One patient with osteosarcoma and 3 with metastatic carcinoma died of multiple organ metastases during 6 months to 2 years after operation.The others had no local relapse.The mean limb discrepancy was 5.0 cm (range,2.0-7.5 cm).The mean Enneking score was 23 (range,20-27).All patients needed custom-made shoes with heightened heel of 2-3 cm.Osteonecrosis of the femoral head was not found in radiographic images.Eight cases had formed artificial acetabulum.One case had gentle lumbar scoliosis.Conclusion The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum had low complications,less pain,low relapse,better function in the recent period.     

The recurrence and the overall survival rates of ovarian serous borderline neoplasms with noninvasive implants is time dependent

Ovarian serous borderline neoplasm with noninvasive implants traditionally have been considered to be nonaggressive tumors associated with an excellent prognosis. However, in our experience, recurrences commonly develop as patients are followed over many years. Eighty cases of advanced-stage ovarian serous borderline tumor with noninvasive implants were identified; the minimum follow-up period for these cases was 5 years or until the death of the patient. The following cases were excluded: patients treated by cystectomy, patients who died of other causes, patients who developed other tumors, and patients who had as the only positive material after resection of the primary borderline neoplasm a tumor detected on a second look or third look operation. Hematoxylin and eosin-stained slides from the original ovarian tumor and the staging biopsies were reviewed in all cases. Slides of the recurrent tumor were available in all cases except for 2 in which the diagnosis was established clinically. The presence or absence of a micropapillary/cribriform pattern and microinvasion in the ovarian tumor was recorded. Follow-up was obtained from the patients' charts. Fischer exact test was used for statistical analysis. The patients' ages ranged from 17 to 67 years (median 36 y). Seventy-three patients were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Seven patients were treated by total abdominal hysterectomy and unilateral salpingo-oophorectomy. The International Federation of Gynecology and Obstetrics stage was as follows: stage II (29 cases), stage III (50 cases), and stage IV (1 case). After surgery, 58 patients were treated with chemotherapy, 7 with radiotherapy, and 1 with hormonal therapy. The follow-up ranged from 5 to 31 years (median 15.7 y). Thirty-five patients (44%) developed recurrences. Only 10% of the patients had a recurrence in less than 5 years, 19% had their recurrences between 5 and 10 years, 10% between 10 and 15 years, and 5% more than 15 years after resection of the primary neoplasm. The only statistically significant feature associated with recurrence was the presence of a micropapillary/cribriform pattern, although this pattern was present in only 26% of the cases that recurred. Of the 35 patients who had a recurrence, 2 were diagnosed clinically, both are alive with progressive disease at 1 and 5 years after the diagnosis of the recurrence; 6 had recurrent serous borderline tumors, all are without evidence of disease with a follow-up ranging from 7 to 18 years after resection of the ovarian borderline tumor (median 14 y); and 27 patients subsequently developed low-grade serous carcinoma, 7 are alive with progressive disease with a follow-up ranging from 10 to 29 years (median 15 y) and 20 died of disease between 3 to 25 years after resection of the ovarian borderline tumor (median 16 y). In summary, the true recurrence rate of ovarian serous borderline tumors with noninvasive implants can only be obtained through a long follow-up. In this group of patients, 77% and 34% of the subsequent tumors developed 5 years and 10 years after diagnosis of the ovarian tumor, respectively. Histologic examination of the recurrent tumor is important in determining further therapy and prognosis for these patients; all patients who recurred with borderline tumor are without evidence of disease, whereas 74% of the patients who recurred with low-grade serous carcinoma died of disease. We propose that patients be followed for a minimum of 10 years to evaluate for recurrences and for 20 years to evaluate for survival.     

骨血管源性恶性肿瘤的临床分析

目的 回顾性分析临床上少见的血管源性恶性骨肿瘤的诊断、治疗和临床疗效.方法 从1998年10月至2008年11月我科诊治7例骨血管源性恶性肿瘤患者,包括5例血管内皮瘤和2例血管肉瘤.男4例,女3例;年龄19～76岁,平均42.6岁.1例为多中心病变,6例为单中心.1例病变位于椎体,其余6例位于四肢骨.所有患者均以局部疼痛就诊,病变影像学表现均为溶骨性破坏.其中2例血管肉瘤伴有软组织包块.1例脊柱病变接受边缘切除和术后放疗,5例接受广泛切除重建或截肢术,未行放化疗,另外1例放弃治疗.所有患者均经病理学诊断确诊,平均随访40个月(1～89个月).结果 股骨上段血管肉瘤患者半盆截肢后于术后17个月死于肺和内脏多发转移.脊柱血管内皮瘤患者术后3年死于其他原因.胫骨上端血管内皮瘤患者术后6年出现局部软组织复发,予以再次完整切除.保守治疗的患者带瘤生存,其他3例患者均无瘤生存.结论 骨的血管源性恶性肿瘤临床少见,主要根据病理学检查确诊,同一解剖部位的多中心病灶对诊断有一定特异性.手术广泛切除为治疗四肢病变的主要手段,椎体病变瘤内刮除后可辅以术后放疗.血管肉瘤恶性程度高、预后差.     

原位微波灭活术治疗骨盆恶性骨肿瘤的临床研究

目的 探讨原位微波灭活术治疗骨盆原发恶性肿瘤及转移瘤的疗效.方法 2000年2月至2009年4月对18例骨盆原发恶性肿瘤及转移瘤患者采用原位微波灭活及肿瘤全部或部分切除,男11例,女7例;年龄16～72岁,平均45岁.原发恶性骨肿瘤12例,转移瘤6例.肿瘤累及Ⅰ区6例、Ⅱ区10例、Ⅲ区2例.根据肿瘤所在区域采用传统髂腹股沟切口或髂腹股沟"T"形切口进行显露,以铜网保护周围软组织,用2450 MHz微波将肿瘤局部加热至50℃,持续20 min,全部或部分剥离坏死肿瘤组织,保留骨盆环的解剖连续性.结果 手术时间60～180min,平均110min;术中失血量400～800ml,平均480 ml.无严重的术中及术后并发症.随访0.5～7年,平均3.5年.1例软骨肉瘤患者术后8个月复发,随访6个月带瘤生存.1例恶性纤维组织细胞瘤患者术后24个月出现肺、脑和全身多发转移死亡.1例骨肉瘤患者术后18个月出现肺转移死亡.6例骨盆转移瘤患者中5例分别于术后6～19个月出现其他部位转移而死亡.术后3个月18例患者患侧髋关节屈曲80°～130°,后伸0°～10°,外展25°～35°,内收18°～23°.结论 原位微波灭活术具有操作简便、疗效可靠、创伤小的特点,可用于或辅助用于骨盆恶性骨肿瘤的治疗,能保持骨盆环的完整性.

Abstract：

Objective To investigate the clinical outcomes of microwave heliotherapy in situ on the primary or metastatic malignant tumors of the pelvis.Methods From February 2000 to April 2009,18 patients with primary or metastatic malignant tumors of the pelvis were treated with microwave heliotherapy in situ,and followed a total or partial tumor resection.There were 11 males and 7 females with an average age of 45 years(range,16-72).Twelve cases were diagnosed as primary malignant tumor and 6 as metastases.Locations of tumors involved:the Ⅰ region 6 cases.the Ⅱ region 10 cases.and the Ⅲ region 2 cases.The exposures of all tumors were via a"T"type or ilioinguinal approach.The lesions were heated at 50℃ for 20 min by 2450 MHz microwave,with surrounding soft tissue protected by copper.mesh.The necrotic tumor tissues were total or partial excised after treatment,with preservation of the anatomical continuity of the pelvic ring.Results The duration of surgery was 60-180 min (110 min on average).The blood loss was 400-800ml(480 ml on average).All patients were followed-up for 0.5-7 years(3.5 years on average).Tumor local recurred in 1 case with chondrosarcoma,and was survival in tumor-bearing after 6 months follow up.One case with malignant fibrous histiocytoma died due to brain,pulmonary,and all body metastases.One case with osteosarcoma died due to pulmonary metastases.Five cases with the metastases died due to non-pelvis metastases.Functions of hip joint in 18 patients were as follows:flexion 80°-130°,extension 0°-10°,abduction 25°-35°,and adduction 18°-23°.Conclusion The clinical result demonstrated that the advantages of microwave heliotherapy in situ were quick increase of temperature,sensitive responses,easy control of temperature,and effective inactivation of tumor cells in the malignant bone tumors of pelvis.     

骶骨骨巨细胞瘤的外科治疗

目的 探讨骶骨骨巨细胞瘤外科切除边界与局部复发率及骶神经保留节段与神经功能的关系.方法 对1996年8月至2008年8月行肿瘤切除的48例骶骨骨巨细胞瘤患者进行回顾性分析,男20例,女28例;年龄19～74岁,平均34.7岁.肿瘤累及S1～S5 4例,S1～S4 7例,S1～S3 15例,S1,2 12例,S2～S5 8例,S3～S5 2例.采用单纯后路29例,前后联合入路19例.整块切除2例,边缘切除12例,边缘切除加刮除25例,刮除9例.术后定期随访,观察局部复发情况与骶神经功能.结果 41例随访18～115个月,平均43.5个月.术中出血量550～12000 ml,平均3560 ml.1例发生良性肺转移,2例发生肉瘤变后死亡.15例肿瘤原位复发,其中整块切除复发率0(0/2)、边缘切除18.2%(2/11)、边缘切除加刮除40.9%(9/22)、单纯刮除66.7%(4/6).边缘切除局部复发率低于单纯刮除,差异有统计学意义.保留双侧S3神经根者大小便功能障碍发生率7.4%(2/27),保留单侧S3神经根者33.3%(4/12),差异有统计学意义.结论 外科切除边界与骶骨骨巨细胞瘤局部复发率相关,在注意保留骶神经根的前提下应以边缘切除为目标;保留双侧S3神经根可使绝大部分患者的括约肌功能得以恢复.

Abstract：

Objective To discuss the relations between optimal surgical margin and local recurrence and the impact of preserving segment of sacral nerve root on neural functions based on the clinical and pathological features of giant cell tumor(GCT).Methods From August 1996 to August 2008,48 patients with sacral GCT undergoing tumor resection were respectively analyzed,including 20 males and 28 females with an average of 34.7 years(range,19-74).The tumors were located in S1-S5 in 4 patients,S1-S4 in 7,S1-S3 in 15,S1,2 in 12,S2-S5 in 8,and S3-S5 in 2.Surgical methods included single posterior approach in 29 cases,combined anterior-posterior approach in 19.The surgical margins adopted were en-bloc in 2 patients,marginal in 15,marginal and curettage in 25,and curettage in 9.Results Forty-one of 48 cases were successfully followed up,the average time was 43.5 months(range,18-115).The average blood loss during surgery was 3560 ml(range,550-12 000).Benign lung metastasis occurred in one case 6 years after operation,2 patients died of malignant transformation.Local recurrence occurred in 15 cases.The recurrence rates in patients with en-bloc resection,marginal resection,marginal resection combined with curettage,and curettage were 0,18.2%,40.9%,66.7%,respectively.The recurrence rate of marginal group was significantly lower than that of the curettage group.Of 27 cases with bilateral S3 nerve root preservation,2 sufiered from urine or fetal dysfunction.with an incidence rate of 7.4%.While 4 of 12 patients with unilateral S3 nerve root preservation suffered from sphincter disturbance,with an incidence rate of 33.3%.The significant difference between groups in nerve root preservation was confirmed.Conclusion Optimal surgical margin for sacral GCT is of great importance to local control of tumor recurrence,the surgical procedure of sacral GCT should aim at the marginal resection on the basis of rational sacral nerve roots preservation;preservation of bilateral S3 nerve roots contributes to the recovery of sphincteral function in most patients.     

骶骨肿瘤切除ISOLA重建骨盆环稳定

目的探讨骶骨肿瘤切除术后应用ISOLA重建骨盆环稳定的疗效。方法手术治疗32例骶骨肿瘤患者。肿瘤切除后均应用ISOLA行腰骶部内固定植骨融合,其中24例行前后联合入路,结扎双侧髂内动脉;8例行单纯后路肿瘤切除植骨融合内固定。结果术后经过6个月～5年的随访,术后感染去除内固定1例,因肿瘤复发死亡3例,再手术3例,失访5例,余患者术后症状均明显改善,植骨融合好,骨盆环稳定,内固定物无松动,未发现断钉断棒现象。结论骶骨肿瘤切除术后应用ISOLA重建下腰椎及骨盆环稳定,疗效满意。     

髂骨翼肿瘤的切除与重建

目的 探讨髂骨翼肿瘤切除及重建方式。方法1998年7月至2004年7月,61例髂骨翼肿瘤患者接受髂骨肿瘤切除重建手术。其中男38例,女23例;年龄12～78岁,平均43岁。根椐Enneking骨盆肿瘤分区：肿瘤累及Ⅰ区36例,Ⅰ、Ⅱ区17例,Ⅰ、Ⅳ区8例。肿瘤切除术后,检查骨缺损的大小,将钉棒系统应用于髂骨肿瘤切除后的缺损重建中。对于肿瘤累及Ⅳ区的患者,行钛网杯重建髋臼顶及全髋置换术。对于儿童患者,采用植骨或斯氏针＋骨水泥固定。结果61例髂骨肿瘤切除的患者中48例患者获得随访,随访时间为16个月至6年,平均43个月。其中33例存活,无肿瘤局部复发迹象;15例死亡。36例行Ⅰ区肿瘤切除的患者中,19．4％（7／36）出现局部复发;17例行Ⅰ、Ⅱ区肿瘤切刮、骨水泥填充、髋臼重建的患者中,35．3％（6／17）出现局部复发;8例行Ⅰ、Ⅳ区肿瘤切除的患者中,1例死于围手术期,50．0％（4／8）局部复发。功能结果：36例行Ⅰ区肿瘤切除的患者,术后有正常行走功能。17例行Ⅰ、Ⅱ区肿瘤刮除、骨水泥填充、髋臼顶重建、人工髋关节置换的患者,术后髋关节功能基本正常。结论可将钉棒系统应用于成人患者髂骨肿瘤切除后的缺损重建中,维持骨盆环的完整。对于儿童的髂骨肿瘤切除后的重建,应尽量采用比较简单的固定。可应用异体骨或自体髂骨（取自残存的部分髂骨）植于髂骨颈与骶骨翼之间,用加压螺丝钉固定。     

脊柱原发软骨肉瘤的外科治疗

目的：探讨脊柱原发软骨肉瘤的治疗方法及预后。方法：对1993年-2005年收治的16例脊柱原发软骨肉瘤进行回顾性分析。男9例，女7例；年龄19—69岁，平均44岁。累及胸椎7例，腰椎2例，胸腰椎多发1例，骶椎6例。8例伴神经损伤症状，Frankel分级C级3例，D级5例。1例骶骨巨大软骨肉瘤因去分化改变采取化疗，因化疗无效患者放弃治疗出院；其余15例均行手术治疗，根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除术，并予以相应重建方式。结果：15例手术患者术后随访1—13年，平均6．2年。1例死于术后肺栓塞。术前有神经症状者中1例Frankel C级患者术后无改变，其余7例（87．5％）术后Frankel分级均改善1个等级。2例出现去分化改变，于术后12个月内死亡。术后复发7例，占47％（7／15），复发1次者4例（4／15，27％），复发2次以上者3例（3／15，20％）。除1例去分化软骨肉瘤外，其余6例每次复发后均行手术再次切除。至今存活12例，生存时间1-19年，平均7．5年。结论：对于脊柱原发软骨肉瘤，首选广泛性切除，对难以达到广泛切除者．应尽量争取彻底切除；对复发肿瘤，仍应争取再次手术并尽可能彻底切除，可达到一定的生存时间及功能保留。     

骶骨包虫病的临床诊断及治疗分析

目的探讨骶骨包虫病的临床特点,为临床诊断和治疗提供依据。方法回顾分析1999年7月-2010年8月收治的14例骶骨包虫病患者临床资料。男6例,女8例;年龄16～58岁,平均28.7岁。病程6个月～11年,中位病程5.7年。其中12例来自畜牧区或有明显犬、羊密切接触史;12例有肺包虫或肝包虫病病史。主要临床症状为腰骶部及双下肢疼痛,一侧或双侧下肢及会阴部感觉减退,逐渐出现双下肢活动及大小便功能障碍、排尿无力等神经损害表现。影像学检查示多囊性骨质破坏。10例行包虫囊液皮内Casoni试验,其中8例呈阳性,2例呈阴性;4例行包虫病8项免疫血清学检查均为阳性。所有患者彻底清除病灶后,采用自体骨、同种异体骨、人工骨或骨水泥修复缺损。术后常规使用阿苯达唑,持续3个月预防复发。结果术后切口均Ⅰ期愈合,无相关并发症发生。术后14例均获随访,随访时间6个月～11年,中位时间5.7年,患者术前临床症状均缓解。8例于术后6个月～3年复发,其中5例行3次清创手术,1例行5次清创手术,2例行病灶边缘切除联合高速磨钻清理;术后未见复发,症状均不同程度缓解。患者术后均未出现包虫病局部种植或远处播散。结论骶骨包虫病临床症状不典型,易误诊、漏诊,结合MRI检查有助于骶骨包虫病的诊断,血清学检查是诊断骶骨包虫病的主要方法,手术是最主要的治疗方法。     

直肠类癌(附26例报告)

为探讨直肠类癌的病理学特点、诊断及治疗选择,对我院１９８７～１９９７年１０年间收治的２６例直肠类癌病例进行回顾性总结。２６例术前均行直肠镜检查并经病理学检查而确诊,其中１９例分别做了局部切除或局部扩大切除,７例因肿块直径大于２ｃｍ而行根治性手术。术后随访１～１０年,死亡５例。作者认为,直肠镜检查是术前发现直肠类癌的重要手段,对可疑病变行活检时,除常规行ＨＥ染色外,应加做嗜银染色、亲银染色以及免疫组化检查。手术治疗是其最佳的治疗方法,手术切除的范围取决于原发肿瘤的大小、浸润程度、淋巴结受累及肝转移等情况     

隆凸性皮肤纤维肉瘤的诊断和治疗

目的 探讨隆凸性皮肤纤维肉瘤（DFSP）的诊断和治疗方法。方法 分析第二军医大学长海医院收治的DFSP病人11例,均由手术后病理确诊。其中DFSP纤维肉瘤型（DFSP-FS）4例。肿瘤位于躯干部9例,位于四肢2例。2例行局部常规切除,其余9例均行扩大切除术。3例在术后行放射治疗,平均剂量55Gy（50—65Gy）。结果 切除11例标本,CD34阳性10例,阴性1例。术后随访1—10年（平均4．3年）,失访1例。复发6例,平均复发时间2、6年（10个月至5年）。11例均未见有远处转移,无死亡。结论 DFSP在临床上易与其他软组织肿瘤相混淆。诊断主要依据病理。治疗DFSP最主要的方法是扩大的手术切除,切缘阳性或肿块太靠近切缘的辅以放疗。单独使用放疗可以作为偶见的无法切除肿块的治疗方式。     

腹腔内隐睾恶变3例报告

目的 探讨腹腔内隐睾恶变为巨大精原细胞瘤的临床特点.方法 回顾性分析2007年6月至2011年1月我院收治的3例腹腔内隐睾恶变为巨大精原细胞瘤患者的临床资料及诊治方法,并复习相关文献.结果 3例患者的平均年龄为32.3岁,均表现为隐睾、腹痛及盆腔内肿块.3例最终均行手术治疗,术后病理类型均为精原细胞瘤.术后1个月开始给予放疗或化疗.随访0.5至5年,例1术后5年,健在,性功能正常,未生育;例2术后4.5年,健在;例3术后0.5年,健存.结论 腹腔精原细胞瘤大多继发于隐睾,隐睾患者腹盆腔有增大的肿块应高度怀疑隐睾恶变,手术切除加放化疗较理想.隐睾患者需早期诊断、治疗及长期随访.     

Combined posterior pelvis and lumbar spine resection for sarcoma

The oncologic outcome in the treatment of pelvic sarcomas is not comparable with that in the extremity. Particular problems arise when the tumor involves the posterior pelvis and the sacrum or even the lower lumbar spine. Because of the difficulty in achieving local control and the major functional deficits after extensive surgery, some authors suggest conservative, nonsurgical treatment for these patients. The purpose of the current study was to analyze the oncologic outcome of patients who were treated for a pelvic sarcoma necessitating resection of the ilium, part of the sacrum and part of the lower spine, which is defined as extended hemipelvectomy. Between 1979 and 1999, 11 males and seven females with a mean age of 34.5 years (range, 14-67 years) had an extended hemipelvectomy for a sarcoma of the posterior pelvis. The tumors included seven osteogenic sarcomas, six chondrosarcomas, and five fibrosarcomas: 13 were classified as high-grade lesions. The mean size of the tumor was 11 x 9 x 6 cm. In 11 patients, a hemivertebrectomy of L5 and in seven patients of L4 combined with L5 was done to achieve an adequate margin. In four patients, the resection was followed by reconstruction with a vascularized fibula or autograft. At a mean followup of 56 months (range, 3-220 months), 12 of 18 patients were alive and without disease. Six patients died; four of these patients had metastasis to the lung at presentation. The two remaining patients died of complications of adjuvant treatment. The authors conclude from this small series of patients that an aggressive surgical resection for localized, nonmetastatic, high-grade sarcomas of the posterior pelvis may be justified to provide local control and improve survival.     

骨巨细胞瘤手术治疗的临床观察

目的：观察骨巨细胞瘤患者手术治疗的疗效。方法：23例均手术治疗，其中肿瘤切除 碘酊、酒精局部灭活 骨水泥填塞术14例，肿瘤瘤段切除 人工金属假体置换术4例，截肢术2例，肿瘤切除 病灶清除术2例，肿瘤刮除 植骨术1例。结果：治愈20例，死亡3例。术后随访2年～7年5个月，平均3年6个月。结论：我们提倡GCT采用临床、X线和病理三结合方法，临床疗效满意。对提高诊断和治疗有很大的价值。     

老年骨肉瘤10例治疗总结

目的探讨老年骨肉瘤（≥60岁）的临床特点和治疗效果。 方法回顾性分析2007年1月至2017年3月期间山东大学齐鲁医院骨科收治的≥60岁的骨肉瘤患者10例,女性8例,男性2例,年龄60~76岁,平均（66±6）岁,病变位于股骨5例、踝关节软组织1例、多中心1例、骨盆（Ⅲ区）1例、肱骨1例、距骨1例。确诊后行截肢术2例,截肢术结合化疗2例,广泛切除术1例,广泛切除术结合化疗3例,边缘切除结合放疗1例,单纯化疗1例。 结果10例患者中,4例就诊时病史已超过6个月,2例就诊时已出现肺转移,5例合并基础疾病,2例血清ALP水平升高（>125 U/L）。影像学方面,7例为混合型,1例为溶骨型,1例为成骨型,1例位于软组织。肿瘤组织类型方面,普通型骨肉瘤7例,骨旁骨肉瘤2例,髓内高分化性骨肉瘤1例。10例患者随访3.5~124个月,平均（40±37）个月。1例接受单纯化疗的肺转移患者于明确诊断后3.5个月死亡,另1例肺转移患者接受转移灶射频消融术,随访58个月带瘤生存,1例距骨骨肉瘤复发后行截肢术。其余7例均未出现肿瘤复发或远处转移。 结论老年骨肉瘤临床较为少见,具有不同于青少年骨肉瘤的临床特点和预后,应早期明确诊断,采取适合患者自身情况的治疗方法,以尽可能降低复发和转移的发生率,延长生存期。