CAJ | 학술논문

目的回顾性分析骨盆肿瘤复发再手术病例,探讨其合理的手术指征、切除重建方式、肿瘤学和功能预后.方法2010年1月至2011年1月,共8例骨盆原发恶性肿瘤复发再手术病例,6例行肿瘤整块切除及重建手术,2例行半骨盆截肢.平均36(27~58)岁.男5例,女3例.软骨肉瘤6例、恶性骨巨细胞瘤1例、恶性纤维组织细胞瘤1例.结果平均手术时间5(3.0~8.5) h,术中平均出血2300(1100~7500) ml.4例为 I+IV 型切除,1例为 II+IV+H 型切除,1例为 II 型切除,2例半骨盆截肢,无围手术期死亡患者.平均随访12(8~23)个月,围手术期并发症:2例术后出现伤口并发症,清创后二期愈合,坐骨神经损伤1例,深静脉血栓1例,髋关节脱位1例,1例出现局部复发.结论骨盆肿瘤局部复发率高,再次手术难度大,须合理的掌握手术适应证,降低再手术并发证,良好的切除范围和手术风险控制可获得较好的肿瘤学及功能预后.
목적회고성분석골분종류복발재수술병례,탐토기합리적수술지정、절제중건방식、종류학화공능예후.방법2010년1월지2011년1월,공8례골분원발악성종류복발재수술병례,6례행종류정괴절제급중건수술,2례행반골분절지.평균36(27~58)세.남5례,녀3례.연골육류6례、악성골거세포류1례、악성섬유조직세포류1례.결과평균수술시간5(3.0~8.5) h,술중평균출혈2300(1100~7500) ml.4례위 I+IV 형절제,1례위 II+IV+H 형절제,1례위 II 형절제,2례반골분절지,무위수술기사망환자.평균수방12(8~23)개월,위수술기병발증:2례술후출현상구병발증,청창후이기유합,좌골신경손상1례,심정맥혈전1례,관관절탈위1례,1례출현국부복발.결론골분종류국부복발솔고,재차수술난도대,수합리적장악수술괄응증,강저재수술병발증,량호적절제범위화수술풍험공제가획득교호적종류학급공능예후.
Objective To review and analyze the cases of re-operations on recurrent pelvic tumors, and to explore the rational operation indications, methods of resection and reconstruction, oncology and functional prognosis. Methods There were 8 cases of re-operations on recurrent primary malignant tumors of the pelvis from Jan. 2010 to Jan. 2011. Among them, 6 cases underwent en bloc tumor excisions and reconstruction. 2 cases underwent hemi-pelvic amputation. They had an average age of 36 years old ( range;27-58 years ) with 5 males and 3 females. There were 6 cases of chondrosarcoma, 1 case of malignant giant cell tumor and 1 case of malignant fibrous histiocytoma. Results The mean surgical time was 5 hours ( range; 3-8.5 hours ). The mean blood loss was 2300 ml ( range; 1100-7500 ml ). 4 cases were of type I+IV resection, 1 case was of type II+IV+H resection, and 1 case was of type II resection. 2 cases underwent hemi-pelvic amputation. There was no death during perioperative time. The mean follow-up period was 12 months ( range;8-23 months ). Perioperative complications:2 patients ( 25%) had wound complications after the operation and were healed by second intention after debridement. 1 patient had sciatic nerve injuries. 1 patient had deep vein thrombosis. 1 patient had dislocation of the hip joint. 1 patient had local recurrence ( 12.5%). Conclusions The local recurrence rate of pelvic tumors is high. Re-operation is difficult. Hence we must reasonably control the surgery indications and reduce the operative complications. Proper extent of surgical resection and risk control can acquire well oncology and functional prognosis.