靶血管栓塞后手术治疗复发性骶骨脊索瘤的疗效分析

目的探讨靶血管栓塞后手术治疗复发性骶骨脊索瘤的临床疗效。方法对1993～2008年间36例骶骨脊索瘤患者进行回顾性分析，将27例初发患者列为初发组，外院初次手术后复发来我院9例列为复发组。所有患者均采用靶血管栓塞后行后路手术。统计学分析两组病例术中出血量、输血量、术后引流量、伤口并发症、术后二便功能和复发情况。结果两组患者平均出血量、平均输血量、术后引流量差异无统计学意义,P〉0．05。平均随访68个月，复发组术后大小便功能障碍较初发组多（P〈0．05）。初发组复发10例，复发组再次复发7例，差异有统计学意义（P〈0．05）。结论选择性靶血管栓塞可有效地减少术中出血，对于复发性骶骨脊索瘤仍是安全有效的方法。复发性骶骨脊索瘤术后大小便功能恢复较初发患者差，并且较初发患者更易复发。

Surgical treatment of recurring sacral chordoma after target arterial embolization

Objective To investigate the curative effect of surgical treatment for recurring sacral chordoma after target vessel embolization. Methods Thirty-six patients with sacral chordomas which were from 1993 to 2008 were retrospectively analysed. All patients were divided into 2 groups： primary group （n=27）, and recurring group （n=9）. All patients underwent surgery with a posterior approach after target arterial embolization. Blood loss, blood transfusion, blood drain, wound complication, post-operative function of the bladder and rectum, and the recurrence in both groups were analyzed. Results There was no significant difference in blood loss, blood transfusion, blood drain between two groups （P〉0.05）. The average follow-up was 68 months. The post-operative function of bladder and rectum of the recurring group was worse than that of the primary group （P〈0.05）. There were ten patients had relapse in primary group, and seven patients in recurring group. The difference was significant （P〈0.05）. Conclusions Target arterial embolization can decrease the blood loss and increase the possibility to remove the sacral chordoma completely. So it is a safe and effective method for recurring sacral chordoma. The post-operative function of bladder and rectum of recurring patients is worse than that of primary patients, and the recurrence rate is higher.