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目的:探讨骶骨巨大良性神经源性肿瘤的手术治疗策略。方法:2000年6月~2015年12月,共收治骶骨良性巨大神经源性肿瘤188例,其中神经纤维瘤137例,神经鞘瘤51例。男93例,女95例;年龄17~75岁(42.3±10.4岁)。初次手术患者167例,外院术后复发21例。术前影像学诊断为神经源性肿瘤,均未行穿刺活检。肿瘤局限于骶管内或巨大相对低位(S1以下)的骶前神经源性肿瘤采用单纯经后路分块切除方式完整切除肿瘤;对于巨大相对高位(S1以上)的骶前神经源性肿瘤采用前后联合入路手术切除;肿瘤下界高于S2水平的骶前神经源性肿瘤采用前路手术切除。术后均经病理证实。结果:手术时间75~420min(185±61min),出血量500~5000ml(1600±908ml)。行单纯后路手术切除肿瘤165例,前后路联合手术切除肿瘤16例,单纯前路手术切除肿瘤7例;除9例体积较小的肿瘤整块切除外,其余病例均行分块完整切除。1例死于围手术期失血性休克、弥散性血管内凝血(DIC);3例因累及骶骨范围太大,出血较多,未能保留S2以下神经根,术后出现大小便困难,但均未行膀胱、直肠造瘘。其余病例均保留了双侧S3以上神经根,术后患者均未出现大小便功能障碍。随访10~126个月(59±23个月),16例术后局部复发,局部复发率8.5%。结论:对骶部神经源性肿瘤应根据肿瘤生长的部位及大小来决定手术入路,整块或分块完整切除肿瘤可取得较好的临床疗效。
Objective: To explore the surgical treatment of giant benign neurogenic tumors of the sacrum. Methods: From June 2000 to December 2015, a total of 188 cases of benign giant neurogenic tumors of the sacral sac were treated, including 137 neurofibroma and 51 schwannoma. There were 93 males and 95 females, aged from 17 to 75 years (42.3 ± 10.4 years). There were 167 cases of primary surgery and 21 cases of postoperative recurrence. Preoperative imaging diagnosis of neurogenic tumors, did not line biopsy. The tumors were confined to sacral canal or sacral presacral neurogenic tumors with large relative low position (below S1). Complete resection of the tumor was performed by simple posterior block excision. For presacral neurogenic tumors with large relative height (S1) Combined approach for surgical resection; lower than the tumor level of S2 sacrococcygeal neurogenic tumors using anterior resection. Postoperative pathological confirmed. Results: The operative time ranged from 75 to 420 minutes (185 ± 61 minutes) and the blood loss was from 500 to 5000 ml (1600 ± 908 ml). Totally 165 cases were removed by simple posterior approach, 16 cases were resected by anterior and posterior approach, and 7 cases were resected by anterior resection alone. All the cases except for 9 cases were resected with smaller tumors. One patient died of perioperative hemorrhagic shock and disseminated intravascular coagulation (DIC). Three patients had too much sacral involvement and hemorrhage due to involvement of the sacrum, and failed to preserve nerve root below S2. Not bladder, rectostomy. The remaining cases were retained more than bilateral nerve root S3, postoperative patients did not appear stool dysfunction. The follow-up ranged from 10 to 126 months (59 ± 23 months). Local recurrence was found in 16 cases and local recurrence rate was 8.5%. Conclusion: For sacral neurogenic tumors, surgical approach should be decided according to the site and size of tumor growth. Complete or partial complete resection of tumor can achieve better clinical efficacy.