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目的探讨原发性骶骨巨细胞瘤的外科治疗方法。方法对2000年2月～2008年2月收治的22例原发性骶骨巨细胞瘤患者进行回顾性研究,其中侵犯S_2及以下8例,侵犯达S_1者14例。行后路单纯肿瘤切除3例,前后路联合切除、腰骶重建7例,单纯后路肿瘤切除、腰骶重建12例。结果22例患者无围手术期死亡。3例出现切口延迟愈合,2例经换药愈合,1例行臀大肌肌瓣转移覆盖后愈合。20例患者获随访,平均随访时间44个月(16～85个月)。4例复发,3例经再次手术获得良好控制,1例带瘤生存。4例患者出现术后大小便功能障碍,其中3例在术后2周出院时已有缓解,另1例经理疗后于术后1年内逐渐改善。1例术后11个月出现内固定松动,取出内固定。其余患者腰骶部症状缓解,双下肢感觉及运动功能良好。结论合理的手术方式和应用ISOLA等有效的腰骶部重建方式可使骶骨巨细胞瘤患者获得良好的局部控制,并可最大程度保留术后功能。
Objective To investigate the surgical treatment of primary sacral giant cell tumor. Methods Twenty - two patients with primary sacral giant cell tumor who underwent surgery from February 2000 to February 2008 were retrospectively studied. Among them, 8 cases were infiltrated with S_2 and below, and 14 cases were infiltrated with S_1. Three cases were treated with simple tumor resection, combined anterior and posterior resection, lumbosacral reconstruction in 7 cases, simple posterior resection and lumbosacral reconstruction in 12 cases. Results 22 patients without perioperative deaths. In 3 cases, delayed incision healed, 2 cases healed by dressing change, and 1 case had gluteus maximus muscle flap healed after healed. Twenty patients were followed up for an average of 44 months (range, 16-85 months). 4 patients relapsed, 3 patients underwent reoperation was well controlled, 1 patient with tumor survival. Four patients had postoperative defecation dysfunction, of which 3 patients had been relieved 2 weeks after surgery and the other 1 patient improved gradually within 1 year after operation. One patient had loosening internal fixation 11 months after operation and removed the internal fixation. The remaining patients lumbosacral symptoms, both lower extremity feeling and good motor function. Conclusion The reasonable operation method and the effective lumbosacral reconstruction method such as ISOLA can get good local control in patients with giant cell tumor of sacrum and can preserve the postoperative function to the greatest extent.