CAJ | 학술논문

目的评估累及骶骨的骨盆原发恶性肿瘤骶骨侧外科分型及其在外科边界获得、围手术期风险控制、肿瘤学和功能学改善中的作用.方法 2003年2月至2013年2月,采用手术治疗累及骶骨的骨盆原发恶性肿瘤(修订的EnnekingⅣ型肿瘤)患者59例.男28例,女31例;年龄15～72岁,平均36岁.根据累及的骶骨范围不同将骨盆Ⅳ型肿瘤分为Ⅳa、Ⅳb、Ⅳc、Ⅳd四个亚型,Ⅳa型43例,Ⅳb型9例,Ⅳc型5例,Ⅳd型2例.不同的亚型采取相应的规范化肿瘤切除与重建方法.结果外科边界满意43例(73％,43/59),边界不满意16例(27％,16/59).手术时间2.5～13 h,平均5.0 h;术中出血500,～6 000 ml,平均2 157 ml.没有因围手术期并发症而死亡的病例.53例患者获得随访,随访时间6～88个月,平均26个月.20例(38％,20/53)于术后1～52个月出现局部复发,平均复发时间12个月.10例(19％,10/53)出现转移,20例(38％)在末次随访时仍无瘤生存.美国骨与软组织肿瘤协会(Musculoskeletal Tumor Society,MSTS)93评分平均58.1％,其中Ⅳa型平均57％(10％～100％),Ⅳb型平均66％(13％～100％),Ⅳc型平均45％(13％～77％),Ⅳd型平均30％(26％～33％).结论对EnnekingⅣ区肿瘤根据累及骶骨范围不同进行的亚分型,为手术入路和切除范围提供了依据.根据不同亚型进行手术切除与重建,能够获得良好的外科边界、肿瘤学预后及术后功能,降低手术风险.
목적 평고루급저골적골분원발악성종류저골측외과분형급기재외과변계획득、위수술기풍험공제、종류학화공능학개선중적작용.방법 2003년2월지2013년2월,채용수술치료루급저골적골분원발악성종류(수정적EnnekingⅣ형종류)환자59례.남28례,녀31례;년령15～72세,평균36세.근거루급적저골범위불동장골분Ⅳ형종류분위Ⅳa、Ⅳb、Ⅳc、Ⅳd사개아형,Ⅳa형43례,Ⅳb형9례,Ⅳc형5례,Ⅳd형2례.불동적아형채취상응적규범화종류절제여중건방법.결과 외과변계만의43례(73％,43/59),변계불만의16례(27％,16/59).수술시간2.5～13 h,평균5.0 h;술중출혈500,～6 000 ml,평균2 157 ml.몰유인위수술기병발증이사망적병례.53례환자획득수방,수방시간6～88개월,평균26개월.20례(38％,20/53)우술후1～52개월출현국부복발,평균복발시간12개월.10례(19％,10/53)출현전이,20례(38％)재말차수방시잉무류생존.미국골여연조직종류협회(Musculoskeletal Tumor Society,MSTS)93평분평균58.1％,기중Ⅳa형평균57％(10％～100％),Ⅳb형평균66％(13％～100％),Ⅳc형평균45％(13％～77％),Ⅳd형평균30％(26％～33％).결론 대EnnekingⅣ구종류근거루급저골범위불동진행적아분형,위수술입로화절제범위제공료의거.근거불동아형진행수술절제여중건,능구획득량호적외과변계、종류학예후급술후공능,강저수술풍험.
Objective To evaluate the surgical margin achievement,perioperative risk management and improvement in oncologic and functional result of a surgical classification on sacral side for primary pelvic malignancies involving the sacrum.Methods The study was conducted in 59 patients according to modified Enneking type Ⅳ surgical classification in our center from February 2003 to February 2013.There were 28 males and 31 females,with an average of 36 years old (range,15-72 years).There were 43 cases conform to subtype Ⅳa,9 to Ⅳb,5 to Ⅳc and 2 to Ⅳd according to the extent of sacrum the tumor invades.Distinctive resection and reconstruction methods were designed for each subtype.Results Adequate margins were acquired in 43 cases (73％),while inadequate margins were inevitable in 16 cases (27％).Average operation time lasted 5 hours (range,2.5-13 h).Average blood loss during operation was 2 157 ml (range,500-6 000 ml).No case died of perioperative complications.53 of 59 patients were followed up with an average follow-up time of 26 months (range,6-88 months).Local recurrence occurred in 20 cases (38％,20/53),and average recurrence time was 12 months (range,1-52 months).Metastasis occurred in 10 cases.20 patients (38％) were still surviving without recurrence.Average Musculoskeletal Tumor Society 93 score reached 58％.Average score after subtype Ⅳa resection reached 57％ (range,10％-100％),Ⅳb 66％ (range,13％-100％),Ⅳc 45％ (range,13％-77％),and Ⅳ d 30％ (range,27％-33％).Conclusion The modified Enneking's type Ⅳ surgical classification,which is classified as four distinct subtypes according to the extent the sacrum invaded,defines the standardized surgical approach and resection plane.It plays an important role in surgical margin achievement,improvement in oncologic and functional result,and perioperative risk management.