Guo Wei, Ji Tao, Tang Xiaodong, Yang Yi
Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, People's Republic of China.
Spine (Phila Pa 1976). 2009 May 1;34(10):1025-31. doi: 10.1097/BRS.0b013e31819d4127.
Retrospective analysis.
To estimate the clinical outcome of conservative surgery (intralesional curettage or partial excision) aided by effective intraoperative hemorrhage control in patients with giant cell tumors of the sacrum.
Giant cell tumors of the sacrum present a challenging therapeutic problem. Wide resection is associated with higher morbidity and spinal instability. Whether conservative surgery aided by effective intraoperative hemorrhage control can achieve low recurrence rates remains uncertain.
The clinical records of 24 patients with an average age of 35 years who had undergone conservative surgery for sacral giant cell tumor between 1996 and 2005 were evaluated retrospectively. The disease onset, tumor size, operation records, complications, follow-up status, and functional outcome were analyzed.
The mean duration of follow-up was 58 months (median, 50 months; range: 25-132 months). All the patients had a conservative procedure aided by intraoperative occlusion of the abdominal aorta. The mean estimated blood loss was 3217 mL. The mean length of the operation was 190 minutes. Seven (29.2%) patients developed recurrences. The mean time from the index surgical procedure to the first recurrence was 13 months (range: 8-31 months). The 5-year local recurrence-free survival rate was 69.6%. Seventeen (70.8%) patients retained normal urinary function and 16 (66.7%) patients preserved normal bowel function. No patients had urinary or bowel dysfunction when both S3 nerves were preserved. Ten (41.7%) patients had complications perioperatively or during the follow-up. Seven (29.2%) patients had wound complications.
Considering the acceptable local recurrence rate, conservative surgery aided by effective control of intraoperative hemorrhage should be considered as an alternative procedure for patients with giant cell tumors of the sacrum. The advantages include lower morbidity, reduced neurologic deficits, speed and ease of the surgical procedure, reduced blood loss, preservation of spinal and pelvic continuity, and a low recurrence rate.
回顾性分析。
评估在骶骨巨细胞瘤患者中，通过有效的术中出血控制辅助的保守手术（病灶内刮除或部分切除）的临床结果。
骶骨巨细胞瘤是一个具有挑战性的治疗难题。广泛切除与较高的发病率和脊柱不稳定相关。通过有效的术中出血控制辅助的保守手术是否能实现低复发率仍不确定。
回顾性评估1996年至2005年间接受骶骨巨细胞瘤保守手术的24例平均年龄为35岁患者的临床记录。分析疾病发病情况、肿瘤大小、手术记录、并发症、随访情况和功能结果。
平均随访时间为58个月（中位数为50个月；范围：25 - 132个月）。所有患者均接受了术中腹主动脉阻断辅助的保守手术。平均估计失血量为3217毫升。平均手术时长为190分钟。7例（29.2%）患者出现复发。从初次手术到首次复发的平均时间为13个月（范围：8 - 31个月）。5年局部无复发生存率为69.6%。17例（70.8%）患者保留了正常排尿功能，16例（66.7%）患者保留了正常排便功能。当双侧S3神经均得以保留时，无患者出现排尿或排便功能障碍。10例（41.7%）患者在围手术期或随访期间出现并发症。7例（29.2%）患者出现伤口并发症。
考虑到可接受的局部复发率，术中出血有效控制辅助的保守手术应被视为骶骨巨细胞瘤患者的一种替代手术方式。其优点包括较低的发病率、减少神经功能缺损、手术速度快且操作简便、减少失血量、保留脊柱和骨盆的连续性以及低复发率。
