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目的探讨骨盆肿瘤切除手术入路、手术方法及评估手术疗效。方法收集自1992年1月至2008年11月骨盆肿瘤切除术患者46例,分析患者手术入路、手术方式,随访术后功能及并发症。46例中,年龄32~65岁,平均46.8岁;男性27例,女性19例;恶性骨肿瘤34例,侵袭性良性骨肿瘤12例。全部病人行骨盆部分切除术或骶骨部分切除术,Ⅰ区肿瘤(髂骨)采用沿髂嵴切口,Ⅱ区肿瘤(髋臼周围)采用“人”字切口,Ⅲ区(耻骨、坐骨)采用腹股沟+会阴旁切口;Ⅳ区(骶骨)采用前后路联合切口,其中41例肿瘤完整切除,5例肿瘤巨大分块切除,6例患者行肿瘤灭活再植重建骨盆环,4例用大块异体骨块重建骨盆环,3例用自体骨块重建髋臼。21例肿瘤巨大者术前行肿瘤血管栓塞术。恶性肿瘤术后行适当放疗或/和化疗。结果病例随访时间3~53月,平均32月,46例中,1例术后3月因局部感染合并内在衰竭死亡,2例术后1年因肺转移死亡,43例存活。存活患者中,按Enneking法评分,35例超过23分,功能优良,5例一般,3例差。功能差的主要原因是肿瘤切除中神经切断或切除范围大引起的。结论骨盆肿瘤手术可以取得满意疗效,选择合适的手术入路,完整切除肿瘤,骨盆环重建,尽可能保留重要的神经是手术后取得满意功能的关键。
Objective To investigate the approach of pelvic tumor resection, surgical methods and evaluate the curative effect. Methods 46 patients with pelvic tumor resection from January 1992 to November 2008 were collected. Surgical approach, operation method, follow-up and postoperative complications and complications were analyzed. 46 cases, aged 32 to 65 years, mean 46.8 years; 27 males and 19 females; 34 cases of malignant bone tumors, 12 cases of aggressive benign bone tumors. All patients underwent partial pelvic resection or partial sacrectomy. The tumor (iliac bone) in area I was incised along iliac crest. The tumor in area II (peri-acetabular area) The inguinal region and perineal incision were used. In the region IV (sacrum), antecedent and posterior approach incision was performed. Among them, 41 cases were completely resected and 5 cases were massive resected. 6 cases were treated with tumor inactivation and replantation, Reconstruction of the pelvis ring heterogeneous bone block, 3 cases of autologous bone reconstruction acetabulum. Twenty-one patients with giant tumors underwent preoperative tumor embolization. Malignant tumors after surgery appropriate radiotherapy and / or chemotherapy. Results The patients were followed up from March to May, with an average of 32 months. Among the 46 cases, 1 died of local infection and internal failure in March and 2 died of lung metastasis one year after operation, and 43 survived. Survival patients, according to Enneking method score, 35 cases over 23 points, excellent function, 5 cases in general, 3 cases poor. The main reason for poor function is due to a large excision or excision of the tumor during tumor resection. Conclusion The pelvic tumor surgery can achieve satisfactory results. Choosing the appropriate surgical approach, complete resection of the tumor, reconstruction of the pelvic ring, and preservation of important nerves as much as possible are the keys to achieve satisfactory function after the operation.