恶性骶骨肿瘤的骶骨次全切除

Subtotal sacrectomy for malignant sacral tumor

摘要:

[目的]介绍骶骨恶性肿瘤的骶骨次全切除治疗的手术技术和初步临床效果。[方法]对 8 例骶骨恶性肿瘤患者，行骶骨次全切术。取后侧倒 Y 形切口，于远端分离暴露骶骨直肠间隙，沿间隙向近端钝性分离骶骨前方，切断双侧梨状肌，切断 S₂~S₅神经根，保护双侧 S₁神经根，在 S₁神经根下方将硬脊膜切断并予以结扎，双侧骶髂关节切断骶髂关节连接处，于 S_1/2间隙水平整体凿断骶骨骨面，整块切除骶骨巨大肿瘤。L₄、L₅置入椎弓根螺钉，双侧髂骨分别置入 2 枚髂骨螺钉，用连接棒连接固定。[结果]所有患者中，1 例出现切口感染、1 例出现皮缘坏死；1 例出现切口血肿，但无严重不良后果。随访 3 个月~5 年，无复发及转移病例，无死亡。[结论] 骶骨次全切除术治疗骶骨恶性肿瘤手术复杂，需妥善保护 S₁神经，固定骶髋关节，以保留功能。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of subtotal sacrectomy for the malignant sacral tumor. [Methods] A total of 8 patients received subtotal sacrectomy for the malignant sacral tumor. After a posterior inverted Yshaped incision was made to separate and expose the sacral rectal space at the distal end, and the space anterior to the sacrum was freed by blunt separation to the proximal end. The bilateral piriformis muscle and S₂~S₅ nerve roots were severed, while the bilateral S₁ nerve roots were preserved and protected, and the dural sac was cut and repaired below the S₁ nerve roots. The sacrum was cut with disarticulated the sacroiliac joint bilaterally at the S_1/2 space, and then the huge sacral tumor was removed en block. Pedicle screws at L₄ and L₅, and two iliac crest screws were inserted, then fixed with connecting rods. [Results] Of the patients, 1 case of incision infection, 1 case of cutaneous necro- sis and 1 case of incision hematoma occurred without serious consequences. As the follow-up ranged from 3 months to 5 years, no recur- rence, metastasis and death happened in anyone of them. [Conclusion] The subtotal sacrectomy for sacral malignancy is a complicated sur- gical procedure, which requires proper protection of S₁ nerve and fixation of sacroiliac joint to preserve the function.