摘要
目的总结骶骨脊索瘤的治疗效果及临床经验。方法1997年7月至2007年7月，共65例骶骨脊索瘤患者接受治疗。随访记录完整患者51例，其中男性32例，女性19例。平均年龄57岁（21-75岁）。首次在我院接受治疗的骶骨脊索瘤患者40例，其余11例为在外院首次手术治疗术后出现局部复发转来我院。S，以下17例均行广泛切除，S，以上34例行切刮术加高压冲洗，术后均进行腰椎和骨盆之间的钉棒重建。结果51例患者平均随访3．5年（15～108个月）。肺转移3例（5．9％），死亡5例。40例第一次手术的患者中，17例出现局部复发（42．5％）。28例第2—3次手术的患者中，再次复发者18例（64．3％）。51例患者共进行79次手术，25例次（31．6％）术后出现伤口并发症。11例次（13．9％）患者术后出现脑脊液漏。结论骶骨脊索瘤为低度恶性局部侵袭性强的肿瘤，广泛切除是治疗骶骨脊索瘤的关键。S，以下的肿瘤可行广泛切除，对于累及S，以上的肿瘤为最大限度的保留神经功能，采用切刮术加高压冲洗可以有效地降低局部复发率。
Objective To analyze the surgical treatment results and experience of sacral chordoma. Methods The data of 51 cases of sacral chordoma surgically treated from July 1997 to July 2007 was retrospectively studied. The age of patients ranged from 21 to 75 years （mean 57 years）, including 32 males and 19 females. Forty patients had the first surgery, while other 11 patients were referred to our hospital because of local recurrence from other hospital. Wide resection for all 17 S3-5 tumors, and wide resection plus plece-meal excision for 34 tumors which involved S3 above. Reconstruction was performed using pedicle screw and rod device to achieve the continuity between the lumbar spine and the pelvis. The oncologic and functional outcomes of 51 patients were reviewed. Results After a mean duration of follow-up of 3.5 years （range from 15 to 108 months）, 5 of 51 patients died of disease. Seventeen of 40 （42. 5% ） patients who underwent first surgery recurred during follow-up, 18 of 28 patients （64. 3% ） got re-relapse after second or third surgeries. Postoperative wound complifications were as high as 31.6%. Conclusions Chordoma is a biologically aggressive low-grade malignant tumor. Wide resection is a prerequisite for curative treatment of sacrococcygeal chordoma, intralesional curettage causes the risk of high local recurrence for which curative resection in a second or third procedure is more difficult to achieve. In order to preserve near normal bowel and bladder function for the tumor which involves S3 above, wide en-bloc resection plus piece-meal excision in the cephalad is performed.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第16期1224-1227,共4页
Chinese Journal of Surgery
