原发性骶前肿瘤的手术切除(附20例临床分析)

目的总结原发性骶前肿瘤的诊断、手术方法及主要并发症。方法回顾性分析20例原发性骶前肿瘤患者资料,临床表现无特异性,经直肠指诊、B超、CT确诊,均行手术切除,其中经腹前切除10例,经骶尾部切除9例,经腹骶尾部联合入路切除1例。结果肿瘤完整切除17例,大部切除3例,其中联合邻近脏器切除3例。发生围手术期并发症7例,其中大出血3例,误伤直肠1例,术后骶尾部切口坏死并感染2例,术后排尿困难1例。16例患者平均随访15(3~36)月,肿瘤完整切除的患者获随访14例,复发2例,死亡1例;大部切除的患者获随访2例,均已死亡。结论原发性骶前肿瘤早期诊断困难,手术时应注意选择合适的入路,良性肿瘤和低度恶性肿瘤应完整切除,并积极防治骶前静脉丛大出血等并发症。

Surgical Treatment of Primary Presacral Tumors (A Report of 20 Cases)

Objective To discuss the diagnosis,surgical approach and complication for primary presacral tumors.Methods Twenty cases of primary presacral tumor were reviewed retrospectively.There was no specificity on the clinical presentations.The main diagnostic approaches of the primary presacral tumors were rectal touch,ultrasonography and computerized tomography(CT).All cases received surgery including transabdominal in 10 cases,transsacroiliac in 9 cases and combined approach in 1 case.Results Tumor was removed as radical resection in 17 cases,subtotal resection in 3 cases,combined organ excision in 3 cases.7 cases experienced complications including massive hemorrhage in 3 cases,rectal injury in 1 case,wound infection in 1 case and dysuria in 1 case.The follow-up showed recurrence of 2 cases and death of 1 case within the 14 cases of radical resection,2 cases were followed in the subtotal resection and turned out to be dead.Conclusions Early diagnosis is difficult to be made for primary presacral tumors.Idealized surgical approach may facilitate the operation.Benign tumor and low potential malignant tumor appeal complete and enbloc resection,operative complications such as massive hemorrhage of presacral venous plexus should be alerted.