中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2009年
5期
487-491
,共5页
华莹奇%张治宇%李健%胡硕%孙伟%李国东%郑龙坡%蔡郑东
華瑩奇%張治宇%李健%鬍碩%孫偉%李國東%鄭龍坡%蔡鄭東
화형기%장치우%리건%호석%손위%리국동%정룡파%채정동
骶尾部%肿瘤%外科手术
骶尾部%腫瘤%外科手術
저미부%종류%외과수술
Sacrococcygeal region%Neoplasms%Surgical procedures,operative
目的 探讨骶部肿瘤的切除与重建方法.方法 对2000年1月至2005年12月间长海医院骨科及普外科收治并进行手术切除的61例(男34例,女27例)骶部肿瘤患者进行回顾性研究.对此类患者的一般情况、临床表现、组织学表现、手术类型以及并发症情况进行评估.患者手术时年龄平均48.5岁(18~71岁).单纯前路经腹切除肿瘤9例(14.8%),单纯后路切除肿瘤22例(36.1%),前后路联合入路30例(49.2%);行腰椎一骨盆重建25例(41.0%),未行腰椎-骨盆重建36例(59.0%).结果 49例患者获得随访,随访时间平均20.5个月(3~72个月).无围手术期死亡病例,1例患者因肿瘤侵蚀范围广术中行血管移植和Miles手术.4例术后2~5年因肿瘤转移死亡;4例肿瘤原位复发,完整切除后未见复发.41例(83.7%)得到1年内良好局部控制,5年局部控制率为69.4%.结论 (1)对于巨大的骶部肿瘤,手术较复杂.应强调根据患者病情制定个体化治疗方案,多学科协作,完整切除肿瘤,并建立和谐的转诊制度;(2)手术入路对于骶部肿瘤切除至关重要,对于巨大的骶部肿瘤,优先选择前后联合入路;(3)切口感染是骶部肿瘤术后常见并发症,因此在围手术期,对于切口感染必须足够重视;(4)对于涉及骶髂关节面的骶部肿瘤须进行腰椎-骨盆内固定重建.
目的 探討骶部腫瘤的切除與重建方法.方法 對2000年1月至2005年12月間長海醫院骨科及普外科收治併進行手術切除的61例(男34例,女27例)骶部腫瘤患者進行迴顧性研究.對此類患者的一般情況、臨床錶現、組織學錶現、手術類型以及併髮癥情況進行評估.患者手術時年齡平均48.5歲(18~71歲).單純前路經腹切除腫瘤9例(14.8%),單純後路切除腫瘤22例(36.1%),前後路聯閤入路30例(49.2%);行腰椎一骨盆重建25例(41.0%),未行腰椎-骨盆重建36例(59.0%).結果 49例患者穫得隨訪,隨訪時間平均20.5箇月(3~72箇月).無圍手術期死亡病例,1例患者因腫瘤侵蝕範圍廣術中行血管移植和Miles手術.4例術後2~5年因腫瘤轉移死亡;4例腫瘤原位複髮,完整切除後未見複髮.41例(83.7%)得到1年內良好跼部控製,5年跼部控製率為69.4%.結論 (1)對于巨大的骶部腫瘤,手術較複雜.應彊調根據患者病情製定箇體化治療方案,多學科協作,完整切除腫瘤,併建立和諧的轉診製度;(2)手術入路對于骶部腫瘤切除至關重要,對于巨大的骶部腫瘤,優先選擇前後聯閤入路;(3)切口感染是骶部腫瘤術後常見併髮癥,因此在圍手術期,對于切口感染必鬚足夠重視;(4)對于涉及骶髂關節麵的骶部腫瘤鬚進行腰椎-骨盆內固定重建.
목적 탐토저부종류적절제여중건방법.방법 대2000년1월지2005년12월간장해의원골과급보외과수치병진행수술절제적61례(남34례,녀27례)저부종류환자진행회고성연구.대차류환자적일반정황、림상표현、조직학표현、수술류형이급병발증정황진행평고.환자수술시년령평균48.5세(18~71세).단순전로경복절제종류9례(14.8%),단순후로절제종류22례(36.1%),전후로연합입로30례(49.2%);행요추일골분중건25례(41.0%),미행요추-골분중건36례(59.0%).결과 49례환자획득수방,수방시간평균20.5개월(3~72개월).무위수술기사망병례,1례환자인종류침식범위엄술중행혈관이식화Miles수술.4례술후2~5년인종류전이사망;4례종류원위복발,완정절제후미견복발.41례(83.7%)득도1년내량호국부공제,5년국부공제솔위69.4%.결론 (1)대우거대적저부종류,수술교복잡.응강조근거환자병정제정개체화치료방안,다학과협작,완정절제종류,병건립화해적전진제도;(2)수술입로대우저부종류절제지관중요,대우거대적저부종류,우선선택전후연합입로;(3)절구감염시저부종류술후상견병발증,인차재위수술기,대우절구감염필수족구중시;(4)대우섭급저가관절면적저부종류수진행요추-골분내고정중건.
Objective To discuss the approaches of resection and reconstruction of sacrum-involved tumors. Methods Based on a review of records in 61 patients (27 females and 34 males) with tumors involved sacrum, who underwent operations between January 2000 and December 2005 in Department of Orthopaedics or General Surgery of Changhai Hospital, a retrospective study was to review the authors" experience with surgical treatment of these patients. Evaluations for the various patient characteristics, clinical manifestation, histological findings, complications as well as the type of surgical treatment used, and the outcomes were reported. Average age at surgery was 48.5 years (range, 18-71 years). 9 patients received tumor resection by single anterior approach, 22 patients by single posterior approach and 30 patients by anterior combined posterior approaches. There were 25 (41.0%) patients received spinal-pelvic reconstruction, while 36 (59.0%) cases did not. Results 49 patients were successfully followed up, the average time was 20.5 months (range, 3-72 months). Up to data, no perioperative death occurred. One patient received vascular tran- splantation and Miles procedure because of tumor erosion. No other major complications occurred. 4 patients died of distant metastasis and 4 had a second operation due to local recurrence. The other 41 patients (83.7%) were well under local controlled within one year and the five-year local control rate is 69.4%. Conchlsion 1) For large tumors violating sacrum, surgery of resection is very complicated. So it should be emphasized that the surgical strategy must be designed individually according to each patient's condition. Surgery should strive to achieve cn bloc resection by multi-discipline cooperation and a harmonious referral system is necessary; 2) The choice of surgical approach is important. For large-size tumors, anterior combined posterior approaches is recommended; 3)Wound infection is a common complication, one must be very cautious to prevent this condition in perioperative period; 4) Tumors involving the sacroiliac joints require to be reconstructed the stability between the lumbar spine and pelvis.