骶骨肿瘤切除术辅助氩氦刀的临床疗效分析

目的：探讨骶骨肿瘤切除术中辅助氩氦刀的临床疗效。方法回顾性分析自2007年1月至2012年12月，我院在骶骨肿瘤手术中运用氩氦刀辅助治疗骶骨肿瘤并获随访的15例。其中男9例，女6例，年龄38～78岁，平均51.3岁。术后病理证实脊索瘤12例，骨巨细胞瘤1例，骶尾部纤维瘤1例，骶骨转移性肿瘤1例。发病部位S28例，S3以下6例，臀部复发1例。本组病程2个月至9年，90%患者存在骶尾部疼痛，6例出现坐骨神经痛，12例出现不同程度的大便干结或小便障碍。本组15例均在骶骨肿瘤切除过程中使用氩氦刀冷冻肿瘤。14例采用前后联合入路，前路采用腹腔镜对肿瘤前方进行分离、暴露，后路运用氩氦刀将肿瘤冻结后完整切除；1例骶骨转移瘤因全身状况差，行单纯后路姑息性手术。结果前后联合入路平均手术时间315min，平均失血量1065ml，平均引流量635ml，术后平均住院时间19.2天。术后获随访5～48个月，平均26个月。存活14例，总生存率93.3%。所有病例均保留双侧S2以上神经根，未出现下肢运动感觉障碍。术前疼痛视觉模拟VAS评分（6.80±1.52）分，出院时VAS评分较术前低，为（2.33±0.90）分，差异有统计学意义（P＜0.001）。术中未出现正常组织冷冻坏死的情况，出院时无骨折、深部感染、发热、神经麻痹及脑脊液漏等并发症。5例切口愈合不良，1例大小便功能障碍较术前加重。15例中2例出现局部复发，复发率为13.3%。结论骶骨肿瘤切除术中辅助氩氦刀可彻底切除肿瘤、减少手术出血、迅速缓解疼痛，术中即时效果明显，近期疗效确切，是一种简单、可行、安全的辅助技术。

An analysis of clinical effects of surgical resection of sacral tumors adjuvant with Cryo-Hit

Objective To evaluate the clinical effects of surgical resection of sacral tumors adjuvant with Cryo-Hit. Methods From January 2007 to December 2012, the clinical data of 15 consecutive patients with sacral tumors who were treated with resection adjuvant with Cryo-Hit and were followed up were retrospectively analyzed. There were 9 males and 6 females, whose average age was 51.3 years old （ range;38-78 years ）. There were 12 cases of chordomas, 1 case of giant cell tumor of bone, 1 case of ifbromatosis in the sacroiliac region and 1 case of metastatic tumor in the sacrum, which were conifrmed by the postoperative pathology. Tumors were found in S2 （ n=8 ） and below S3 （ n=6 ）. Recurrence was noticed in the buttock in 1 case. The course ranged from 2 months to 9 years. Sacrococcygeal pain occurred in 90%of all the patients, sciatica in 6 patients, and bladder and （ or ） rectal dysfunction in varying degrees in 12 patients. All the patients received surgical resection of sacral tumors adjuvant with Cryo-Hit. A combination of anterior and posterior approaches was adopted in 14 patients. In the anterior approach isolation and exposure of tumors was performed under laparoscope, and in the posterior approach Cryo-Hit was used to freeze and completely resect tumors. Palliative posterior surgery was performed alone on 1 patient with metastatic tumor in the sacrum, due to the poor body condition. Results The mean operation time was 315 min, and the mean blood loss was 1065 ml. The mean drainage lfow was 635 ml, and the mean postoperative hospital stay was 19.2 days. All the patients were followed up for an average period of 26 months （ range;5-48 months ）. There were 14 patients alive, and the total survival rate was 93.3%. The bilateral nerve roots in S2 and above were successfully spared in all the patients, and no motor or sensory disturbances of lower limbs were noticed. The Visual Analogue Scale （ VAS ） scores were （ 6.80±1.52 ） points and （ 2.33±0.90 ） points preoperatively and at discharge, and the differences were statistically significant （ P＆lt;0.001 ）. No normal tissue necrosis caused by freeze was found during the operation. No serious complications including fractures, deep wound infections, fever, neurological deifcits or cerebrospinal lfuid leakage were noticed at discharge. Poor wound healing occurred in 5 patients, and bladder and rectal dysfunction became more serious than that before the operation in 1 patient. Among the 15 patients, 2 patients had local recurrence and the recurrence rate was 13.3%. Conclusions Surgical resection of sacral tumors adjuvant with Cryo-Hit is a simple, feasible and safe technique, with the advantages of complete resection, less blood loss and rapid palliation of the pain. The intraoperative instant effects are obvious, and the recent curative results are satisfactory.