全骶骨切除术治疗骶骨多节段恶性肿瘤

Total sacrectomy for primary multilevel malignant sacral tumors

中文关键词:  骶骨  恶性肿瘤  全骶骨切除术

英文关键词:Sacrum  Malignant tumor  Total sacrectomy

中文摘要:

  【摘要】 目的：探讨对骶骨多节段恶性肿瘤施行全骶骨切除术的手术入路、手术方式及适应证。方法：2007年7月至2009年7月，共有6例骶骨恶性肿瘤患者在我院骨肿瘤科接受一期前后联合入路全骶骨切除钉棒系统内固定重建腰骶稳定性手术。其中男性4例，女性2例。年龄20～59岁，平均38.8岁。肿瘤位于S1~S5 4例，S1~S3 1例，L5~S4 1例。脊索瘤2例，软骨肉瘤2例，恶性神经鞘瘤1例，尤文肉瘤1例。结果：6例患者均安全度过围手术期。手术时间11～13h，平均12h。术中出血量3800～5500ml，平均4500ml。6例患者均未出现直肠、膀胱瘘等严重并发症。术中6例患者切断双侧S1神经根，术后出现双足跖屈运动障碍。所有患者经钉棒系统固定重建恢复了腰骶部连续性，术后6例患者均定制矫形鞋，术后6周穿矫形鞋扶拐可下地行走。随访3～25个月，平均10.3个月，未发现局部复发及远处转移病例。结论：一期前后联合入路全骶骨切除重建腰骶稳定性手术对于累及骶骨多个节段的恶性肿瘤可以获得满意的肿瘤学切除边界，但手术难度大，应严格把握手术适应证。

英文摘要:

  【Abstract】 Objective：To investigate the surgical approach and indication of total sacrectomy for primary multilevel malignant sacral tumors.Method：Between July 2007 and July 2009，6 patients with malignant sacral tumors received one-stage total sacrectomy by a combined anterior-posterior approach and rod-screw reconstruction in our center.There were 4 males and 2 females，with the average age of 38.8 years（range，20-59 years）.S1-S4，S1-S3 and L5-S4 were involved in 4，1 and 1 patient respectively.Histological diagnoses were chordoma（2），chondrosarcoma（2），malignant peripheral nerve sheath tumor（1） and Ewing sarcoma（1）.Result：The mean operation time was 12 hours（range，11-13 hours），with the mean intraoperative blood loss of 4500ml（range，3800-4500ml）.There was no perioperative death and severe complications such as visceral leakage in all 6 patients.Bilateral S1 nerve roots were sacrificed in 6 patients and plantar flexion was not noted sequentially.Lumbosacral stability was reconstructed using rod-screw system in all cases.All patients were allowed to ambulate with the aid of crutches 6 weeks after operation.The mean follow-up was 10.3 months（range，3-25 months）.No local recurrence or metastasis was found at final follow up.Conclusion：One-stage total sacrectomy with combined anterior-posterior approach can ensure satisfied oncological margin，however the indication should be strictly limited due to its great surgical challenge.