骶骨骨巨细胞瘤的外科治疗

目的 总结骶骨骨巨细胞瘤外科治疗的结果,评价手术方法、局部复发率及并发症.方法 自1998年至2009年共收治骶骨骨巨细胞瘤患者62例,其中男性30例,女性32例,平均年龄33岁.累及S3以下的3例患者接受单纯后方入路整块切除,其余59例累及S3以上的患者接受低位部分肿瘤切除,高位肿瘤局部刮除手术.其中50例患者接受了术中腹主动脉临时阻断.结果 除1例术后2周死亡外,61例患者平均随访39个月.4例恶性骨巨细胞瘤患者死于肿瘤转移.在48例初次手术患者中,14例（29.2%）复发;另14例复发后就诊的患者中,再次复发6例（42.9%）.7例保留单侧S3及以上神经根的患者中2例发生排尿困难;6例仅保留双侧S2及以上神经根的患者,均发生大小便功能异常.并发症包括19例（36.9%）术后伤口问题,7例脑脊液漏.结论 手术切除是骶骨骨巨细胞瘤的有效治疗方法.在进行有效控制出血的前提下进行肿瘤切刮可以获得一定的局部控制,同时最大程度的保留骶神经功能.

Surgical treatmeant of sacral giant cell tumors

Objective To summarize the clinical outcomes of surgical treatment for sacral giant cell tumors and to evaluate the operation method, local recurrence rate and complications. Methods From 1998 to 2009, 62 patients with sacral giant cell tumors were adopted, including 30 males and 32 females, with an average age of 33 years old. En bloc resection using a pure posterior approach was carded out in 3 patients with tumors below S3 level. In the remaining 59 patients with tumors above S3, the lower part of the tumors was excised and the remaining was locally curetted. Among them, 50 patients accepted temporary aortic occlusion during surgery for blood loss control. ResuLts Except that 1 patient died 2 weeks after surgery, the mean duration of follow-up for the other 61 patients was 39 months. 4 patients with malignant giant cell tumors died of tumor metastasis. The recurrence rate was 29.2% in patients who received initial operation （14 out of 48 patients） and 42.9% in patients who were adopted by our hospital after recurrence （6 out of 14 patients） respectively. Dysuria occurred in 2 out of 7 patients with preservation of unilateral $3 nerve roots and above. 6 patients with preservation of bilateral S2 nerve roots and above had functional disturbances of urination and defecation. The complications included wound healing problems in 19 patients （36.9%） and leakage of cerebrospinal fluid in 7 patients. Conclusions Surgical resection is an effective treatment for sacral giant cell tumors. The tumors can be locally controlled to some extent and neurological function can be preserved to the greatest extent after resection and curettage on condition of the effective control of intraoperative hemorrhage.