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目的:总结手术治疗原发性骶骨肿瘤的临床经验。方法:1991年1月～2009年8月我科手术治疗26例原发性骶骨肿瘤患者,男17例,女9例。就诊时年龄17～71岁,平均48岁。术前结合临床表现、影像学和CT引导下穿刺活检病理结果明确诊断。肿瘤累及S2及以上者15例,采用前后联合入路手术,其中9例瘤体巨大的恶性肿瘤患者术前置入主动脉球囊术中行腹主动脉临时阻断;肿瘤累及S3及以下者11例,采用单纯后路手术。术中尽量保留双侧S2及以上神经根和一侧S3神经根。9例切除S1椎患者同时行腰椎髂骨内固定。结果:所有患者均顺利完成手术,无围术期死亡及严重术中并发症。单纯后路手术患者术中出血量为200～5000ml,平均1995±2076ml;前后联合入路手术者术中出血量为400～6300ml,平均2400±1678ml,其9例术中行腹主动脉球囊阻断者术中出血量为2333ml。术后伤口发生并发症11例,6例不愈合,4例感染,2例皮肤坏死,1例窦道形成,均经换药及清创处理,其中2例行二期肌皮瓣转移术,均治愈。23例术前穿刺活检者22例与术后病理检查结果相符。术后早期神经功能损害加重者11例,随访期间8例完全恢复,3例部分恢复。24例获得9～198个月随访,平均45.6个月,1例恶性周围神经鞘瘤患者术后11个月死于多器官功能衰竭;局部复发9例,其中脊索瘤5例,恶性外周神经鞘瘤3例,神经鞘瘤1例,初次平均复发时间12.2个月。末次随访时,17例患者日常生活和大小便功能基本正常。结论:对于骶骨原发肿瘤术前CT引导下穿刺活检有助于明确诊断;肿瘤累及S3及以下者可采用单纯后路手术,肿瘤累及S2及以上的病例宜采用前后联合入路手术,术中腹主动脉球囊临时阻断可有效减少出血;保留双侧S2以上神经根和至少一侧S3神经根可提高患者生活质量。
Objective: To summarize the clinical experience of surgical treatment of primary sacral tumors. Methods: From January 1991 to August 2009, 26 patients with primary sacral tumors underwent surgery in our department, 17 males and 9 females. At the age of 17 to 71 years old, average 48 years old. Preoperative combined with clinical manifestations, imaging and CT-guided biopsy pathology results clear diagnosis. Tumors involving S2 and above 15 cases, using the combined approach before and after surgery, of which 9 cases of huge tumor patients with malignant tumor preoperatively placed in aortic balloon surgery to temporarily block the abdominal aorta; tumors involving S3 and the following 11 For example, using a simple posterior surgery. Intraoperative as far as possible to retain bilateral S2 and above the nerve root and side of the S3 nerve root. 9 cases of resection of S1 vertebral patients with lumbar spine iliac fixation at the same time. Results: All patients successfully completed the operation without perioperative death and serious intraoperative complications. The operation of simple posterior surgery patients with blood loss was 200 ~ 5000ml, an average of 1995 ± 2076ml; anterior and posterior combined surgery for bleeding in the amount of 400 ~ 6300ml, an average of 2400 ± 1678ml, 9 cases of abdominal aortic balloon obstruction Interrupted intraoperative blood loss of 2333ml. Postoperative complications occurred in 11 cases of wounds, 6 cases of nonunion, 4 cases of infection, 2 cases of skin necrosis, 1 case of sinus formation, both dressing and debridement treatment, 2 cases of second-stage myocutaneous flap transfer, All cured. Twenty-three cases of biopsy before surgery were consistent with postoperative pathological findings. In the early postoperative period, 11 cases had severe neurological damage. In the follow-up period, 8 cases recovered completely and 3 cases recovered partially. 24 cases were followed up for 9 to 198 months with an average of 45.6 months. One patient with malignant peripheral schwannoma died of multiple organ failure at 11 months after operation. There were 9 cases with local recurrence, including 5 cases of chordoma, 2 cases of malignant peripheral nerve sheath 3 cases of tumor, 1 case of schwannoma, the average initial recurrence time was 12.2 months. At the final follow-up, the daily life and urinary function of 17 patients were basically normal. Conclusion: The preoperative CT guided percutaneous biopsy can help confirm the diagnosis of primary sacral tumor. Simple posterior surgery can be used to treat patients with S3 and below tumors. Patients with tumor involving S2 and above should be treated with combined anteroposterior and intraoperative abdomen Temporary closure of the aortic balloon can effectively reduce bleeding; to retain bilateral nerve roots above S2 and at least one side of the S3 nerve root can improve the quality of life of patients.