骶骨肿瘤切除与骶骨重建方式探讨

目的 探讨骶骨肿瘤切除和骶骨重建方式. 方法 对13例原发性骶骨肿瘤患者行肿瘤切除及骶骨重建,骶骨部分切除12例,全骶骨切除1例.全骶骨切除术后给予腰椎与髂骨中华长城内固定器加腓骨植骨术重建后骨盆环,并给予相应的放疗与化疗. 结果 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.本组13例中,1例术后出现排尿困难,1例术后出现脑脊液瘘,1例术后切口感染延期愈合,术后随访6个月～10年,有5例肿瘤复发或转移死亡. 结论 肿瘤的切除方式和骶骨重建及术后综合治疗对预后具有重要的影响,而减少术中出血、保留马尾神经功能以及重建高位骶骨肿瘤术后骨盆负重功能则是提高疗效的关键.

Investigation of resection and reconstruction procedure of sacra tumors

Objective To investigate the way of resection of sacrum tumors and the reconstruction way of the sacra.Method From October 1995 to October 2005,13 patients with sacral tumor were enrolled in our hospital,including 1 case of sacrum tumor located above S3 and 12 cases below S3.After resection,the pelvic-ring was reconstructed with Chinese Great Wall Pedicle Screw System and fibulae graft.Corresponding chemotherapy and radiotherapy were given after operation.Results The short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved to varying degrees.Dysuria occured in 1 case and 1 case experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing.During the follow-up period of 6 months to 10 years,5 cases died of tumor recurrence or metastasis.Conclusion Surgical procedure,reconstruction of the sacra and postoperatively comprehensive treatment have important effects on the prognosis.Meanwhile,it is operative key to lessen operative hemorrhage,reserve the function of caudal equine and rebuild weight loading-function of the pelvis after superior sacrum tumor is removed.