摘要
目的评价骶尾部肿瘤手术治疗的中远期效果。方法回顾分析1993年4月至2010年2月收治的47例骶尾部肿瘤患者,其中包括脊索瘤13例,囊肿6例,骨巨细胞瘤4例,脂肪瘤3例,皮脂腺瘤3例,软骨肉瘤3例,恶性源性肿瘤3例,转移癌3例,纤维瘤2例,畸胎瘤2例,神经纤维瘤、纤维脂肪错构瘤、神经节细胞瘤、良性间叶瘤、低度恶性纤维母细胞瘤、孤立性纤维瘤、恶性神经鞘瘤各1例。术前主要临床症状:骶尾区疼痛37例,臀部及大腿麻痛33例,大小便障碍5例,双侧下肢肿胀、难以入睡1例。术前行选择性瘤血管栓塞术15例。6例行前后路联合手术,41例行后路手术。良性肿瘤全部为瘤外切除,恶性肿瘤为瘤内切除。结果术中出血量500～5000ml,平均3000ml,术前行选择性瘤血管栓塞者术中平均出血量为1300ml。13例失访,余34例患者获得随访2-11年,平均随访时间6.4年。8例脊索瘤术后均反复出现局部复发,最快者为术后1个月复发,因其他脏器发生转移而死亡;4例骨巨细胞瘤3例失访,1例随访3年下肢功能、感觉活动良好,无大小便障碍。3例软骨肉瘤术后1例出现复发后死亡,2例无瘤生存;2例转移性癌和3例恶性源性肿瘤术后均死亡。全部良性肿瘤预后较好。结论骶尾部肿瘤发病率较低,起病隐匿、症状轻微者占多数。术前行选择性瘤血管栓塞能够有效降低术中出血的风险。良性肿瘤可进行边缘完整的切除,预后良好;而单纯手术治疗对骶尾部恶性肿瘤来讲,复发率高,预后差,采用全骶骨切除或手术联合放化疗可望降低术后复发率,改善预后。
Objective To evaluate the medium and long-term efficiency of surgical treatment of sacroeoccygeal tumors. Methods A retrospective study was performed on 47 patients with sacrococcygeal tumors who were absorbed from April 1993 to February 2010, including 13 patients of chordoma, 6 of cyst, 4 of giant cell tumors of bone, 3 of lipoma, 3 of steatadenoma, 3 of chondrosarcoma, 3 of malignant tumors, 3 of metastatic tumors, 2 of fibroma, 2 of dysembryoma and 1 of neurofibroma, fibrous hamartoma, gangliocytoma, benign mesenchymoma, low- grade malignant fibroblastoma, solitary fibrous tumors and malignant neurilemmoma respectively. Preoperative clinical symptoms： 37 patients were presented with sacrococcygeal pain and 33 patients with numbness and pain in the hip and thigh. Functional disturbances of urination and defecation occurred in 5 patients. 1 patient couldn＇t sleep because of the swelling in the lower limbs. 15 patients were operated with optional transcatheter arterial embolization preoperatively. Combined anterior and posterior approaches and posterior approach were used in 6 and 41 patients respectively. All benign tumors were externally debulked while the malignant tumors were internaUy debulked. Results The average blood loss during surgery was 3000ml （range; 500-5000ml）. However, the blood loss was 1300ml on average in patients who were operated with optional transcatheter arterial embolization preoperatively. 34 patients were followed up from 2 years to 11 years with an average of 6.4 years, and the remaining 13 patients were lost. Local recurrence appeared in all 8 patients with chordoma repeatedly, and 1 patient with recurrence after 1 month of the operation was the fastest, who died of the shift of other organs. 3 out of 4 patients with giant cell tumors of bone were lost, and the remaining 1 patient was followed up for 3 years, who was presented with good function, feeling and exercises of lower limbs and without functional disturbances of urination and defecation. 1 out of 3 patients with chon
出处
《中国骨与关节杂志》
CAS
2012年第2期123-127,共5页
Chinese Journal of Bone and Joint
基金
全军医学科研"十二五"面上课题(CWS11C268)
广东省科技计划课题(2007A060101003
2008A060101004)
关键词
骶尾部肿瘤
手术治疗
放疗
化疗
Sacrococcygeal tumor
Surgical treatment
Radiotherapy
Chemotherapy
