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目的评价骶尾部肿瘤手术治疗的中远期效果。方法回顾分析1993年4月至2010年2月收治的47例骶尾部肿瘤患者,其中包括脊索瘤13例,囊肿6例,骨巨细胞瘤4例,脂肪瘤3例,皮脂腺瘤3例,软骨肉瘤3例,恶性源性肿瘤3例,转移癌3例,纤维瘤2例,畸胎瘤2例,神经纤维瘤、纤维脂肪错构瘤、神经节细胞瘤、良性间叶瘤、低度恶性纤维母细胞瘤、孤立性纤维瘤、恶性神经鞘瘤各1例。术前主要临床症状:骶尾区疼痛37例,臀部及大腿麻痛33例,大小便障碍5例,双侧下肢肿胀、难以入睡1例。术前行选择性瘤血管栓塞术15例。6例行前后路联合手术,41例行后路手术。良性肿瘤全部为瘤外切除,恶性肿瘤为瘤内切除。结果术中出血量500～5000ml,平均3000ml,术前行选择性瘤血管栓塞者术中平均出血量为1300ml。13例失访,余34例患者获得随访2-11年,平均随访时间6.4年。8例脊索瘤术后均反复出现局部复发,最快者为术后1个月复发,因其他脏器发生转移而死亡;4例骨巨细胞瘤3例失访,1例随访3年下肢功能、感觉活动良好,无大小便障碍。3例软骨肉瘤术后1例出现复发后死亡,2例无瘤生存;2例转移性癌和3例恶性源性肿瘤术后均死亡。全部良性肿瘤预后较好。结论骶尾部肿瘤发病率较低,起病隐匿、症状轻微者占多数。术前行选择性瘤血管栓塞能够有效降低术中出血的风险。良性肿瘤可进行边缘完整的切除,预后良好;而单纯手术治疗对骶尾部恶性肿瘤来讲,复发率高,预后差,采用全骶骨切除或手术联合放化疗可望降低术后复发率,改善预后。
Objective To evaluate the long-term effect of surgical treatment of sacrococcygeal tumors. Methods A total of 47 patients with sacrococcygeal tumors admitted from April 1993 to February 2010 were retrospectively analyzed. Among them, 13 were chordoma, 6 were cysts, 4 were giant cell tumors, 3 were lipomas, 3 were sebaceous tumors, 3 cases of sarcoma, 3 cases of malignant tumor, 3 cases of metastatic carcinoma, 2 cases of fibroma, 2 cases of teratoma, neurofibromatosis, fibrous fat hamartoma, ganglioneuroma, benign mesenchymoma, low grade malignancy Fibroblastoma, solitary fibroma, malignant schwannoma in 1 case. Preoperative main clinical symptoms: 37 cases of pain in the sacrococcygeal, hip and thigh in 33 cases of stool, toilet 5 cases of disability, bilateral lower limb swelling, it is difficult to fall asleep in 1 case. Preoperative selective tumor thrombosis in 15 cases. Six patients underwent combined anterior and posterior surgery and 41 underwent posterior surgery. All of the benign tumors were resected outside the tumor, and the malignant tumors were resected. Results The intraoperative blood loss of 500 ~ 5000ml, an average of 3000ml, preoperative selective tumor angioplasty were intraoperative bleeding average 1300ml. Thirteen patients were lost to follow-up, and 34 patients were followed up for 2-11 years with a mean follow-up time of 6.4 years. 8 cases of chordoma recurrence occurred after the local recurrence, the fastest one month after surgery recurrence, due to the transfer of other organs and death; 4 cases of giant cell tumor of the three cases were lost, one case followed up for 3 years, lower extremity function , Feel good activity, no urination disorder. One case of chondrosarcoma died after recurrence and two cases survived without recurrence. Two cases of metastatic carcinoma and three cases of malignant tumor died after operation. All benign tumors have a good prognosis. Conclusion The incidence of sacrococcygeal tumor is low, occult onset, mild symptoms accounted for the majority. Preoperative selective tumor thromboembolism can effectively reduce the risk of intraoperative bleeding. Benign tumors can be marginal complete resection, the prognosis is good; and simple surgical treatment of sacrococcygeal malignancy, the recurrence rate is high, the prognosis is poor, the use of total sacrectomy or surgery combined with radiotherapy and chemotherapy is expected to reduce postoperative recurrence rate and improve prognosis .