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目的:评价骶骨原发骨肉瘤的外科治疗效果。方法:回顾性分析2000年6月~2013年12月在我院接受肿瘤切除重建手术的26例骶骨原发骨肉瘤患者资料。其中男15例,女11例;中位年龄28岁(12~68岁)。分析本组患者的手术方式、总体与无进展生存时间以及功能状态。采用卡方检验比较整块切除和分块切除术后复发率。Kaplan-Meier法计算总体生存率,比较整块切除和分块切除组的总体生存率及无进展生存率。结果:16例患者接受整块切除术,10例接受分块切除术。出血量3435.3±1529.0ml(400~6600ml),手术时间6.8±2.4h(3~12h)。无围手术期致死性并发症发生。8例(30.7%)出现伤口并发症,经再次手术治疗后愈合良好。3例保留至少单侧S3及以上神经根的患者,术后大小便功能基本正常;7例保留至少单侧S2及以上神经根的患者中,术后膀胱控尿功能及大便控制部分受损,但均可自行排尿排便;仅保留至少单侧S1以上神经根的6例患者,术后均留置尿管,行自主膀胱功能锻炼,半年后均可拔除尿管,经定时挤压腹部排尿,此类患者均有不同程度的大便困难,但未做结肠造瘘。9例行全骶骨切除的患者均切断双侧S1神经根,5例患者术后出现足的跖屈肌力减弱,但可借助双拐或支具下地行走。术后随访6~87个月(29.7±19.7个月)。13例(50%)患者术后出现远处转移,10例患者(38.5%)出现局部复发(其中5例为局部复发合并远处转移)。术后1年生存率为92.3%,5年生存率为38.7%。整块切除者复发率为3/16(18.8%),分块切除者复发率为7/10(70%),分块切除复发率较整块切除高(P=0.015)。中位生存时间整块切除者为24个月,分块切除者为18个月,总体生存率无统计学差异(P=0.22);中位无进展生存时间整块切除者为19个月,分块切除者为8个月,整块切除者的无进展生存率高于分块切除者(P=0.04)。结论:对于骶骨原发骨肉瘤,整块切除术的局部控制率及无进展生存率优于分块切除术;部分病例可获得长期生存,但5年整体生存率仍较低。
Objective: To evaluate the surgical treatment of sacral primary osteosarcoma. Methods: The data of 26 patients with primary sacral osteosarcoma who underwent tumor resection and reconstruction in our hospital from June 2000 to December 2013 were retrospectively analyzed. Including 15 males and 11 females; median age 28 years (12 to 68 years old). Analysis of the surgical approach in this group of patients, overall and progression-free survival time and functional status. The chi-square test was used to compare the rates of recurrence after resection and segmentectomy. The Kaplan-Meier method was used to calculate the overall survival rate and to compare the overall survival rate and progression-free survival rate in the group of resection and resection. Results: Sixteen patients underwent a total resection and 10 underwent partial resection. Bleeding volume 3435.3 ± 1529.0ml (400 ~ 6600ml), operation time 6.8 ± 2.4h (3 ~ 12h). No perioperative fatal complications occurred. Eight cases (30.7%) had wound complications and healed well after reoperation. 3 patients with at least one side of the nerve root S3 and above patients with normal postoperative bowel function; 7 patients with at least one side of the S2 and above the nerve root in patients with postoperative bladder control urinary function and stool control part of the damage, But all of them can urinate and defecate on their own. Only 6 patients with nerve root of at least one side above S1 were reserved. After operation, all the patients had indwelling catheter, exercised bladder function after 6 months, urinary catheter could be removed six months later, Patients have different levels of stool difficulties, but did not make colostomy. In all 9 patients with total sacrectomy, bilateral S1 nerve roots were severed, and in 5 patients, foot plantar flexion was attenuated after the operation, but walking with double abduction or braces. The patients were followed up for 6 to 87 months (29.7 ± 19.7 months). Thirteen (50%) patients had distant metastases after surgery, and 10 (38.5%) had local recurrences (5 were locally recurrent with distant metastases). The 1-year survival rate was 92.3% and the 5-year survival rate was 38.7%. The resection rate was 3/16 (18.8%) for the resectable masses, 7/10 (70%) for the resectable masses, and higher for the resection excision than for the resectable masses (P = 0.015). The median survival time was 24 months for the resection, 18 months for the resection, and the overall survival was not statistically different (P = 0.22); the median progression-free survival time for the resection was 19 months, Patient who underwent resection for 8 months had higher progression-free survival than that who underwent resection (P = 0.04). Conclusion: For the primary sacral osteosarcoma, the mastectomy local control rate and progression-free survival rate are better than the block resection. In some cases, the long-term survival is obtained, but the overall 5-year survival rate is still low.