目的:探讨骶骨肿瘤的分区方法,选择恰当的手术入路及手术方法。方法:1997年7月到2006年7月,共有251例骶骨瘤患者在我院骨肿瘤科接受手术治疗,年龄8-83岁;男124例,女127例。以S2/3椎间盘为界,将骶骨分为上位骶椎(Ⅰ区)及下位骶椎(Ⅱ区)二区;累及到腰椎定义为Ⅲ区;上位骶椎以椎管中心为界分为前(a)、侧(b)、后(c)三区。肿瘤位于Ⅰa区12例,Ⅰab区22例,Ⅰc区4例,Ⅰabc区28例,Ⅰabbc区9例,ⅠaⅡ区7例,ⅠabⅡ区10例,ⅠabcⅡ区51例,ⅠabbcⅡ区53例,ⅠabcⅢ区5例,ⅠabbcⅢ区3例,ⅠabcⅡⅢ区7例,ⅠabbcⅡⅢ区10例,单纯Ⅱ区30例。单纯累及Ⅱ区的肿瘤均行广泛或边缘性切除;单纯累及Ⅰ区的良性肿瘤均行刮除或边缘性切除;单纯累及Ⅰ区的恶性肿瘤行边缘性切除或广泛切除;同时累及Ⅰ、Ⅱ区的肿瘤采取广泛切除肿瘤的Ⅱ区部分,切、刮除肿瘤的Ⅰ区部分。结果:3例死于围手术期并发症,其中1例术前即有创面严重感染,肿瘤突于皮肤外,术后死于重度感染;1例死于失血性休克;另1例死于多器官功能衰竭。47例术后出现伤口并发症,其中29例需手术清创、引流、二期闭合伤口;7例清创后因皮肤缺损较大,行局部皮瓣转移;25例(10%)患者术后出现不同程度的脑脊液漏,均经抬高床尾、抗生素等非手术治疗愈合。3例出现直肠瘘,经直肠造瘘后愈合。随访9个月-8年,42例转移瘤患者转入他科继续治疗,209例原发肿瘤患者失访31例,死亡34例,复发51例,无瘤存活93例。结论:骶骨肿瘤的外科治疗应根据肿瘤累及骶骨的部位不同选择不同的手术入路及切除方法。即使切除范围要达到S1水平,单纯后方入路仍能完成手术,术后并发症发生率较低。 Objective: To explore the sacral tumor zoning method, select the appropriate surgical approach and operation. Methods: From July 1997 to July 2006, a total of 251 patients with sacral tumors underwent surgical treatment in our department of bone oncology, aged 8-83 years; 124 were male and 127 were female. To S2 / 3 intervertebral disc as a boundary, the sacrum is divided into the upper sacral (Ⅰ area) and the lower sacral (Ⅱ area) two areas; involving the lumbar spine is defined as Ⅲ area; upper sacral vertebral center is divided into the front (a), side (b), after (c) three districts. The tumors were located in zone Ⅰa in 12 cases, in the Iab zone in 22 cases, Ⅰc in 4 cases, Ⅰabc in 28 cases, Ⅰabcc in 9 cases, ⅠaⅡ in 7 cases, ⅠabⅡ in 10 cases, ⅠabcⅡ in 51 cases, Ⅰabc Ⅱ Ⅱ in 53 cases, ⅠabcⅢ 5 For example, Ⅰabbc Ⅲ in 3 cases, Ⅰ abc Ⅱ Ⅲ in 7 cases, Ⅰ abbc Ⅱ Ⅲ in 10 cases, simple Ⅱ in 30 cases. Surgical resection was simple or marginal. The tumors that were only involved in region Ⅰ were all underwent extensive or marginal resection. The benign tumors involving only region Ⅰ were treated by curettage or marginal resection. Surgical excision of marginal resection or extensive excision of tumor in region Ⅰ was involved. Area of ​​the tumor to take a wide range of tumor resection Ⅱ area, cut, curettage of the tumor area Ⅰ. Results: Three patients died of perioperative complications. One patient had serious wounds before operation. The tumor protruded outside the skin and died of severe infection after operation. One patient died of hemorrhagic shock and the other died of multiple complications Organ failure. Of the 47 cases, wound complications occurred after operation, among them, 29 cases needed debridement, drainage and second-stage wound closure. Seven cases had local skin flap metastasis due to large skin defects after debridement; 25 cases (10% There are different degrees of cerebrospinal fluid leakage, have been elevated bed end, antibiotics and other non-surgical treatment of healing. 3 cases of rectal fistula, healed after rectal fistula. During the follow-up period of 9 months to 8 years, 42 patients with metastatic disease were transferred to his department for further treatment. Of the 209 patients with primary tumor, 31 patients were lost to follow-up, 34 died, 51 were relapsed, and 93 survived. Conclusion: Surgical treatment of sacral tumors should be based on different parts of the sacrum involving tumor surgery and removal of different surgical approaches. Even if the resection range is to reach the level of S1, simple posterior approach can still complete the operation, the incidence of postoperative complications is low.