骶骨原发骨肉瘤的外科治疗效果评价

Surgical treatment of primary sacral osteosarcoma

中文关键词:  骨肉瘤  骶骨  外科治疗  预后

英文关键词:Osteosarcoma  Sacrum  Surgical treatment  Prognosis

中文摘要:

  【摘要】 目的：评价骶骨原发骨肉瘤的外科治疗效果。方法：回顾性分析2000年6月~2013年12月在我院接受肿瘤切除重建手术的26例骶骨原发骨肉瘤患者资料。其中男15例，女11例；中位年龄28岁（12~68岁）。分析本组患者的手术方式、总体与无进展生存时间以及功能状态。采用卡方检验比较整块切除和分块切除术后复发率。Kaplan-Meier法计算总体生存率，比较整块切除和分块切除组的总体生存率及无进展生存率。结果：16例患者接受整块切除术，10例接受分块切除术。出血量3435.3±1529.0ml（400~6600ml），手术时间6.8±2.4h（3~12h）。无围手术期致死性并发症发生。8例（30.7%）出现伤口并发症，经再次手术治疗后愈合良好。3例保留至少单侧S3及以上神经根的患者，术后大小便功能基本正常；7例保留至少单侧S2及以上神经根的患者中，术后膀胱控尿功能及大便控制部分受损，但均可自行排尿排便；仅保留至少单侧S1以上神经根的6例患者，术后均留置尿管，行自主膀胱功能锻炼，半年后均可拔除尿管，经定时挤压腹部排尿，此类患者均有不同程度的大便困难，但未做结肠造瘘。9例行全骶骨切除的患者均切断双侧S1神经根，5例患者术后出现足的跖屈肌力减弱，但可借助双拐或支具下地行走。术后随访6~87个月（29.7±19.7个月）。13例（50%）患者术后出现远处转移，10例患者（38.5%）出现局部复发（其中5例为局部复发合并远处转移）。术后1年生存率为92.3%，5年生存率为38.7%。整块切除者复发率为3/16（18.8%），分块切除者复发率为7/10（70%），分块切除复发率较整块切除高（P=0.015）。中位生存时间整块切除者为24个月，分块切除者为18个月，总体生存率无统计学差异（P=0.22）；中位无进展生存时间整块切除者为19个月，分块切除者为8个月，整块切除者的无进展生存率高于分块切除者（P=0.04）。结论：对于骶骨原发骨肉瘤，整块切除术的局部控制率及无进展生存率优于分块切除术；部分病例可获得长期生存，但5年整体生存率仍较低。

英文摘要:

  【Abstract】 Objectives: To evaluate the current surgical therapy of primary sacral osteosarcoma. Methods: From June 2000 to December 2013, 26 patients with primary sacral osteosarcomas underwent surgeries in the department of musculoskeletal tumor, People′s Hospital of Peking University. There were 15 males, 11 females, with a median age of 28 years(12-68 years). Chi-square test was used to compare local recurrence rate between two types of resection(en bloc vs piecemeal resection). Kaplan-Meier method was used to analyze the overall survival rate, and the differences of overall survival rate and progressive free survival rate were compared between two types of resection. Results: Among all 26 patients, 16 cases received en bloc resection while 10 accepted piecemeal resection. The average blood loss was 3435.3±1529.0ml(400-6600ml). The average operation time was 6.8±2.4h(3-12h). No fatal complications occurred during perioperative period. 8 patients were complicated with wound complications and received debridement. 3 patients were complicated with unilateral S3 nerve root injury but could maintain normal bowel and bladder function. 7 cases suffered from unilateral or bilateral S2 nerve root injury and experienced partial bowel and bladder dysfunction, but all gradually improved and could defecate and urinate by themselves. Only 6 cases with unilateral or bilateral S1 nerve root injury needed indwelling catheter, however these cases had bladder function recovered and removed the catheter at about half a year. The patients with bowel dysfunction received no colostomy. 9 cases with bilateral S1 resection had weakness in plantar flexion, but could walk with crutch or foot orthosis. The mean follow-up period was 29.7±19.7 months(6-87 months). 13(50%) patients were diagnosed as metastasis and 10 cases developed local recurrence(5 of 8 patients also had metastasis). The overall survival rate was 92.3%, the 1-year and 5-year survival rate was 38.7%. Patients with en bloc resection had lower local recurrence rate compared with those with piecemeal resection[3/16(18.8%) vs. 7/10(70%), P=0.015] and higher progressive free survival rate(median survival, 19 months vs. 8 months, P=0.04). Conclusions: En bloc resection is superior to piecemeal resection in recurrence control and improving free survival rate. Some cases can achieve long-term survival, though current 5-year survival rate is still low.