原发骶骨肿瘤手术治疗应注意的有关问题

目的探讨原发骶骨肿瘤手术治疗的相关问题。方法回顾分析10年间,我院收治的29例原发骶骨肿瘤的临床资料。男16例,女13例。平均32.6岁。病程1年4个月～3年。低位14例,高位15例。偏位17例,中央12例。骨巨细胞瘤13例,脊索瘤8例,软骨肉瘤4例,神经纤维瘤2例,副神经节瘤和黑色素瘤各1例。单纯后入路骶骨肿瘤切除或刮除术19例,前后联合入路骶骨肿瘤切除或刮除术10例;同期行腰骶椎骨盆内固定11例。结果所有患者均在全麻下顺利完成手术,无术中死亡。术中出血平均为1800ml。14例低位肿瘤,13例术后神经功能正常,1例神经功能恢复不理想。15例高位肿瘤中,术后1例失访,12例神经功能恢复,2例神经功能异常。21例患者获得平均4年10个月的随访,5例复发,2例死亡,余14例正常。结论应根据肿瘤的位置高低选择恰当的手术入路;采用前入路时同时结扎髂内血管,可减少术中出血;在不影响肿瘤切除的前提下,尽可能保留双侧S1～2及至少一侧S3神经根,或一侧S1～3神经根,可获得较理想的神经功能恢复;高位骶骨肿瘤应根据情况采取不同的固定方式重建腰骶髂稳定性。

Related problems in surgery of primary sacral tumors

Objective To study related problems in the surgery of primary sacral tumors in order to improve its effect. Methods During past 10 years,29 patients with primary sacral tumors underwent operation in our hospital. Sixteen of the patients were male,13 were female,and with the mean age of 32. 6 years old. The course of disease was from 16 months to 36 months. Fourteen tumors located in low sacrum,15 in high; 17 in dissymmetry,12 in central location. There were 13 giant cell tumors of bone,8 chordomas,4 chondrosarcomas,2 neurofibromas,and one paraganglioma and melanoma respectively. Nineteen patients underwent sacral tumor resection or curettage operation through posterior approach,10 patients with anteroposterior combined approach. Internal fixation of lumbosacral vertebrae and pelvis were performed in 11 cases at the same time. Results All operations were performed under general anesthesia. During operation,no patients died,the mean bleeding amount was 1800 ml. After operation,13 patients had normal lumbosacral nerve functions among 14 cases of low sacral tumors. Among 15 high sacral tumors,12 patients with post-operative nerve functions. The follow-ups were done on 21patients with the mean time of 58 months,5 recurrences occurred,two died. Conclusions It was important to decrease the missed diagnosis of sacral tumor by correct examination methods. The choice of operative approach should be on the location of tumor. In order to diminish bleeding,the internal iliac artery ligation should be performed. It was as far as possible of preserving both S1-2 root and one side S3 root or one side S1-3 root to obtain ideal postoperative nerve function. It was necessary to perform internal fixation to reconstruct lumbo-sacral-iliac stability for high sacral tumors.