骶骨肿瘤的类型和临床特点

The types and clinical characteristics of sacral tumors

中文关键词:  骶骨  肿瘤  类型  诊断

英文关键词:Sacrum  Tumor  Type  Diagnosis

中文摘要:

  【摘要】 目的：分析骶骨肿瘤的类型分布及临床特点。方法：1998年7月~2009年6月，我院骨肿瘤中心诊治445例骶骨肿瘤患者，男228例，女217例。年龄5~83岁，平均46.4岁。352例患者就诊时有严重腰骶部和/或下肢疼痛，93例患者因发现局部包块就诊。所有患者均有术后病理诊断。回顾分析所有患者的临床和影像学资料。结果：原发骶骨肿瘤351例，男174例，女177例，平均年龄44.4岁。其中脊索瘤95例，男62例，女33例，平均年龄55.7岁，骶尾区疼痛是主要症状（82例），半数以上患者伴有坐骨神经痛，肿瘤多先累及低位骶骨（S3~S5）；神经源性肿瘤76例，男36例，女40例，平均年龄47.7岁，神经纤维瘤43例，神经鞘瘤24例，恶性神经鞘瘤9例，主诉多为坐骨神经痛、会阴部麻木（36例）和无痛性包块（11例），20例患者为查体或其他原因检查时发现，67例骶骨良性神经源性肿瘤起源于S3以上神经者54例，起源于S3以下神经者3例，发生于骶前未累及骶管者10例；骨巨细胞瘤60例，男24例，女36例，平均年龄32岁，腰骶尾部不适（37例）、坐骨神经痛（21例）是主要的临床表现，肿瘤多先累及上位骶骨（S1~S2）；骶骨其他原发良性肿瘤及瘤样病变56例，包括畸胎瘤、皮样囊肿、表皮样囊肿共24例；其他原发恶性肿瘤64例，包括软骨肉瘤17例，尤文肉瘤14例，多发性骨髓瘤12例，成骨肉瘤6例等。转移性骶骨肿瘤94例，男54例，女40例，平均年龄54.1岁，包括不明来源转移瘤23例，肺癌转移13例，肾癌转移12例，大肠癌转移10例等。结论：脊索瘤、神经源性肿瘤和骨巨细胞瘤是骶骨常见的三大肿瘤，占骶骨原发肿瘤的2/3。对于出现腰骶部疼痛、下肢疼痛的患者，应警惕骶骨肿瘤的可能。根据患者年龄、病灶部位及影像学表现，可以作出相对正确的初步诊断。

英文摘要:

  【Abstract】 Objective：To investigate the type and clinical characteristics of sacral tumors.Method：Clinical documents，image data and pathological diagnoses of 445 sacral tumors treated in our center between 1998 and 2009 were reviewed retrospectively.There were 228 males and 217 females，with the average age of 46.4 years.The chief complaints included pain in lower limbs or mass in 352 and 93 patients respectively.Result：351 cases had primary sacral tumors，including 174 males and 177 females，with the average age of 44.4 years.98 patients（average，55.7 years） were diagnosed as chordoma with higher involvement in males（62） than in females（33）.82 patients presented with sacrococcygeal pain and more than half of them had sciatica. Lower sacrum（S3-S5） was involved in 56 cases and S1-S5 or S2-S5 were involved in 39 cases.76 patients were diagnosed as neurogenic tumors，which included neurofibroma（43），schwannoma（24），and malignant schwannoma（9）.There were 36 males and 40 females，with the average age of 47.7 years.36 patients presented with sciatica and perineal numbness，11 patients had painless mass and the other 20 were identified due to other causes.Among 67 benign neurogenic tumors，54 were originated from S1-S3 nerves，3 from S4-S5 nerves and 11 from the presacral space without caudal involvement.Giant cell tumor was found in 60 patients，which included 24 males and 36 females，with an average age of 32 years.Upper sacrum（S1-S2） was involved firstly.There were 56 patients（average，37.7 years） diagnosed as other primary benign bone tumors，which included 24 cases of teratomas，epidermoid cyst or dermoid cyst.Other malignant tumors，including chondrosarcoma （17），Ewing′s sarcoma/PNET（14），multiple myeloma（12），lymphoma（6） and osteosarcoma（6） were found in 64 patients.Metastatic tumors were confirmed in 94 patients with origin of undefined in 23 cases，lung cancer in 13 cases，kidney cancer in 12 cases and colorectal cancer in 10 cases.There were 54 males and 40 females with an average age of 54.1 years.Conclusion：Approximately 2/3 primary sacral tumors are chordoma，neurogenic tumor or giant cell tumor.Patients presenting with low back pain，sciatica and caudal equine function abnormality should be considered to have sacral tumor，which can be preliminarily diagnosed based on age，lesion location and characteristic image findings.