高位骶骨肿瘤切除与重建方式探讨

目的 探讨高位骶骨肿瘤切除和重建方式。方法 我院于1998年10月至2002年4月,收治35例原发性高位骶骨肿瘤患者,L5-S14例,L5-S22例,S14例,S1-28例,S1-36例,S1-46例,S1-55例;肿瘤切除方式：L5-S1椎节切除4例,L5-S5椎节切除2例,全骶骨切除9例,骶骨部分切除20例。肿瘤切除术后给予腰椎与骨盆TSRH或ISOLA内固定术,并给予相应的放疗与化疗。结果 术后随访6～42个月,1例术后出现排尿困难,2例术后出现脑脊液瘘,1例术后切口感染及延期愈合,1例尾端切口皮肤坏死,术后近期疗效均较满意,患者腰骶部疼痛及神经功能有不同程度改善,1例脊索瘤和2例恶性纤维组织细胞瘤患者于术后1年复发,其中1例恶性纤维组织细胞瘤患者于术后19个月因肺部转移全身衰竭死亡,所有患者均未发生断钉、断棒。结论 肿瘤的切除方式和术后综合治疗对预后具有重要的影响,骶骨切除术后腰椎与骨盆内固定术有利于保持腰椎及骨盆的稳定性,更好地减轻疼痛,保留患者的行走功能。

Investigation of resection and reconstruction procedure of high-sacrum tumors

OBJECTIVE: To investigate the way of resection of high-sacrum tumors and the way and duration of the spinal-pelvic TSRH or ISOLA internal fixation. METHOD: From October 1998 through April 2002, 35 patients with sacral tumor were enrolled in our hospital, including 4 cases in L(5)-S(1), 2 in L(5)-S(2), 4 in S(1), 8 in S(1 - 2), 6 in S(1 - 3), 6 in S(1 - 4), 5 in S(1 - 5). 35 patients were followed by lumbo-pelvic TSRH or ISOLA internal fixation and corresponding chemotherapy and radiotherapy. RESULTS: In the follow-up period of 6 - 42 months, the short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 case and skin necrobiosis at coccygeal incision occurred in 1 case; two cases experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing, 1 case with chodoma and 2 cases with malignant fibrous histocytoma recurred 1 year after postoperation, one of these 2 cases with malignant fibrous histocytoma suffered from lung metastasis and died of system failure 19 months after postoperation. No fractured rod occurred. CONCLUSION: Surgical procedure and postoperative comprehensive treatment have important effects on the prognosis. High-sacral tumor resection and reconstruction are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.