原发性骶骨肿瘤的诊断和多学科综合治疗

目的 掌握原发性骶骨肿瘤的诊断依据，评估多学科综合治疗的效果。方法 回顾64例骶骨肿瘤的临床资料，了解原发性骶骨肿瘤的特点，分析手术步骤和引起并发症的原因及预防措施，并对多学科综合性治疗的结果进行随访分析。结果 根据临床症状、体征及影像学改变可作初步诊断，肛门指诊可帮助诊断，结合穿刺活检及病理检查可明确诊断。53例获得随访，无术中死亡，术后5年内死亡9例(16．9％)，术后复发17例(32．07％)，术后发生尿失禁、直肠损伤各3例。经过化、放疗的28例恶性骶骨肿瘤患者术后5年生存率达到了89．2％，而未做相应治疗的20例患者术后5年生存率为52．8％。53例中44例功能结果满意(83．01％)。结论 肛门指诊可协助诊断；全身状况较好的原发性骶骨肿瘤为手术适应证；术后复发与手术不彻底有关；化疗和放疗对不同的骶骨肿瘤有一定的疗效；综合治疗是治疗骶骨肿瘤的方向。

Diagnosis and composite treatment for the primary sacrum tumors

Objective To study the diagnostic basis of primary sacrum tumors and evaluate the efficacy of surgical and other synergetic treatments. Methods Clinical data and their X-ray, CT or MRI characters of 64 patients with original sacrum tumors were reviewed and analyzed.Surgical process,causes of complications and preventive measures were detailed.And the results of surgical and chemotherapy or radiotherapy treatment were followed up. Results Primary diagnosis could be made on the basis of clinical symptoms, physical signs and imaging. Rectal touch can help the diagnosis. The difinite diagnosis can be made on the biopsy. 53 patients were followed up. No operative death while 9 patients were dead(16.9%) within 5 years after operation.17 cases had postoperative recurrence (32.07%). There were injured rectums and urinary incontinence in 3 cases, respectively. The relapse-free survival rate of five years of 28 malignant tumor patients was 85.3% with chemotherapy and radiotherapy, and the relapse-free survival rate of five years of 20 malignant tumor patients was 52.8% only with operation. 44 of 53 cases revealed satisfactory functionary results(83.01%).Conclusion Rectal touch can help the diagnosis. Postoperative recurrence is related to incomplete tumor removal.Primary sacrum tumors with good general condition are operative indication.The chemotherapy and radiotherapy can help to improve the results of surgical treatment on distinct original sacrum tumors. The synergetic treatment is the best way for the primary sacrum tumors.