论文部分内容阅读
目的:初步探讨后路直切口经骶尾骨开窗入路切除骶前肿瘤的疗效。方法:回顾性分析2018年4月至2020年4月福建医科大学附属协和医院神经外科收治的9例骶前肿瘤患者的临床资料，所有患者均行后路直切口经骶尾骨开窗入路切除骶前肿瘤。统计所有患者的手术切口长度、术中出血量、手术时长及住院时长。术后复查腰骶部CT或MRI，判断肿瘤切除程度。出院后对所有患者行门诊随访，随访内容包括：复查腰骶部CT或MRI，判断肿瘤复发情况；行视觉模拟量表(VAS)评分，评估疼痛改善情况。结果:9例患者术中均未损伤输尿管和大动脉，手术切口的长度[n M(范围)]为8(2~12)cm，术中出血量[n M(范围)]为50(30~500)ml，手术时间[n M(范围)]为180(100~390)min，住院时间[n M(范围)]为7(5~14)d。术后1例患者伤口周围出现水泡，经积极治疗后愈合。术后复查腰骶部CT或MRI显示，8例为肿瘤完全切除，另1例为大部分切除。术后病理学检查结果显示，神经鞘瘤4例，脊索瘤3例，肠源性腺癌1例，高分化软骨肉瘤1例。9例患者的随访时间[n M(范围)]为21(13~37)个月。随访期间，1例患者肿瘤复发(脊索瘤)，再次行手术治疗；另8例未复发。至末次随访，9例患者的VAS评分[n M(范围)]为0(0~5)分，较术前[7(6~8)分]显著下降(n u＝-2.53，n P＝0.011)。n 结论:后路直切口经骶尾骨开窗入路切除骶前肿瘤的损伤小，术中出血量少、术后并发症发生率低且术后恢复快。“,”Objective:To preliminarily explore the efficacy of posterior straight incision sacrococcygeal fenestration for resection of presacral tumors.Methods:We retrospectively analyzed the clinical data of 9 patients with presacral tumors admitted to the Department of Neurosurgery, Union Hospital Affiliated to Fujian Medical University from April 2018 to April 2020. The length of the incision, intraoperative blood loss, operation time and hospital stay of all patients were counted. Postoperative CT or MRI of the lumbosacral region was performed to determine the degree of tumor resection. After discharge, outpatient follow-up was performed for all patients. The follow-up included re-examination of lumbosacral CT or MRI to determine tumor recurrence and evaluation of pain improvement using the visual analog scale (VAS).Results:The ureter or aorta was not damaged during the operation in 9 patients. The length of the incision [n M(range)] was 8 (2.0-12.0) cm, the median intraoperative blood loss[n M(range)] was 50 (30-500) ml, the operation time was 180 (100-390) min, and the hospital stay[n M(range)] was 7(5.0-14.0) days. One patient developed blisters around the wound after operation, which healed after active treatment. Postoperative re-examination of lumbosacral CT or MRI showed that complete tumor resection was achieved in 8 cases and major resection in 1 case. Postoperative pathological examination revealed 4 cases of schwannoma, 3 cases of chordoma, 1 case of intestinal adenocarcinoma, and 1 case of well-differentiated chondrosarcoma. The follow-up time[n M(range)] of 9 patients was 21 (13-37) months. During the follow-up period, 1 patient had tumor recurrence (chordoma) and underwent surgery again; the other 8 patients did not have recurrence. At the last follow-up, the VAS[n M(range)] score of 9 patients was 0 (0-5), which was significantly lower than that before operation [7(6-8), n u=-2.53, n P=0.011].n Conclusion:Posterior straight incision sacrococcygeal fenestration for resection of presacral tumors seems to be associated with less damage, less intraoperative blood loss, low postoperative complication rate and faster postoperative recovery.