切刮术治疗骶骨骨巨细胞瘤的结果评价

Clinical outcome of intralesional curettage for sacrum giant cell tumor

中文关键词:  骨巨细胞瘤  骶骨  切刮术

英文关键词:Giant cell tumors  Sacrum  Intralesional curettage

中文摘要:

  【摘要】 目的：在有效控制出血的前提下，评价切刮术治疗骶骨骨巨细胞瘤（giant cell tumor，GCT）的临床效果。方法：自2000年7月~2007年7月我院共收治骶骨GCT患者43例。有随访记录的35例。其中男18例，女17例。年龄16~61岁，平均32岁。GCT位于S1～S5者5例，S1～S4者9例，S1～S3者12例，S1～S2者3例，S2～S5者2例；S3～S5者1例；L5～S1者3例。31例患者进行了病灶内切除术，有4例患者进行了广泛切除术。23例患者联合应用术中腹主动脉临时阻断术：其中6例采用了前路手术腹膜后分离腹主动脉阻断，17例采用了术前X线介入下腹主动脉植入球囊，术中临时阻断腹主动脉血流的方法。未行血管阻断12例。随访12个月~8年5个月，平均37个月。术后除1例患者肉瘤变后接受辅助放疗，其余均未接受辅助放疗。结果：血管阻断组平均失血量为3278ml，未行血管阻断者手术平均失血量为5150ml，两组间比较出血量差异有显著性（P<0.01）。14例患者术后出现切口并发症（40%），经过手术引流、清创后伤口愈合。7例患者术后出现不同程度的脑脊液漏，均经抬高床尾、应用抗生素等非手术治疗愈合。血管阻断组局部肿瘤复发率为30.43%（7/23），血管未阻断组复发率为66.67%（8/12），两组肿瘤复发率比较差异有显著性（P<0.05）。结论：对骶骨GCT行切刮术治疗，术中采用血管阻断技术，可以显著降低术中出血，有利于肿瘤的彻底切除并降低术后复发率。

英文摘要:

  【Abstract】　Objective：To evaluate the surgical outcome of intralesional curettage for sacral giant cell tumor under effective blood control.Method：A total of 43 patients with sacrum giant cell tumor were reviewed retrospectively，of these，35 cases were followed up.There were 18 males and 17 females with the average age of 32 years（range，16-61 years）.The lesion site was noted as S1-S3 in 12 cases，S1-S4 in 9，S1-S5 in 5，S1-S2 in 3，S2-S5 in 2 and S3-S5 in 1 respectively，in addition，3 cases had L5-S1 segments involved.A large soft tissue mass and devoid calcification usually presented in all cases.All patients were treated surgically with intralesional and marginal resection in 31 and wide resection in 4.Of the 35 patients，23 underwent intraoperative blood control by temporary abdominal arterial blockade（artery blocking group），which included 6 tourniquet block of abdominal aorta through anterior approach and 17 balloon occlusion of abdominal aorta introduced from femoral artery under fluoresce guide before operation.The other 12 patients did not receive abdominal aorta blockade（artery unblocking group）.No patients received radiotherapy after operation except one progressing into malignant tumor.All cases were followed up for an average of 37 months（range，12-84 months）.Result：The average blood loss was 3278ml for blocking group and 5150ml for unblocking one，which showed significant difference between two groups （P=0.006）.14 cases（40%） were complicated with postoperative incision problems which resolved after debridement and drainage.7 cases experienced cerebrospinal fluid leakage after operation，which was healed through conventional treatment and intravenous antibiotics.In this study，local recurrence rate was　30.43%（7/23） for blocking group and 66.67%（8/12）for unblocking group，which showed statistical difference between two groups（P=0.03）.Conclusion：Temporary abdominal aorta blockade during the resection of sacral giant cell tumor can effectively reduce operative blood loss and ensure complete tumor removal as well as reducing the local recurrence rate.