Guo Wei, Yan Tai-qiang, Tang Xiao-dong, Yang Yi
Department of Orthopaedic Oncology, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 15;47(16):1224-7.
To analyze the surgical treatment results and experience of sacral chordoma.
The data of 51 cases of sacral chordoma surgically treated from July 1997 to July 2007 was retrospectively studied. The age of patients ranged from 21 to 75 years (mean 57 years), including 32 males and 19 females. Forty patients had the first surgery, while other 11 patients were referred to our hospital because of local recurrence from other hospital. Wide resection for all 17 S(3-5) tumors, and wide resection plus piece-meal excision for 34 tumors which involved S(3) above. Reconstruction was performed using pedicle screw and rod device to achieve the continuity between the lumbar spine and the pelvis. The oncologic and functional outcomes of 51 patients were reviewed.
After a mean duration of follow-up of 3.5 years (range from 15 to 108 months), 5 of 51 patients died of disease. Seventeen of 40 (42.5%) patients who underwent first surgery recurred during follow-up, 18 of 28 patients (64.3%) got re-relapse after second or third surgeries. Postoperative wound complications were as high as 31.6%.
Chordoma is a biologically aggressive low-grade malignant tumor. Wide resection is a prerequisite for curative treatment of sacrococcygeal chordoma, intralesional curettage causes the risk of high local recurrence for which curative resection in a second or third procedure is more difficult to achieve. In order to preserve near normal bowel and bladder function for the tumor which involves S(3) above, wide en-bloc resection plus piece-meal excision in the cephalad is performed.
分析骶骨脊索瘤的手术治疗结果及经验。
回顾性研究1997年7月至2007年7月手术治疗的51例骶骨脊索瘤患者资料。患者年龄21至75岁（平均57岁），其中男性32例，女性19例。40例患者首次手术，另11例因其他医院局部复发转至我院。17例S(3 - 5)肿瘤均行广泛切除，34例累及S(3)以上的肿瘤行广泛切除加分块切除。采用椎弓根螺钉和棒装置进行重建，以实现腰椎与骨盆的连续性。回顾51例患者的肿瘤学和功能结局。
平均随访3.5年（15至108个月）后，51例患者中有5例死于疾病。40例首次手术患者中有17例（42.5%）在随访期间复发，28例二次或三次手术后患者中有18例（64.3%）再次复发。术后伤口并发症高达31.6%。
脊索瘤是一种生物学行为侵袭性的低度恶性肿瘤。广泛切除是骶尾部脊索瘤根治性治疗的前提，瘤内刮除术会导致局部高复发风险，二次或三次手术更难实现根治性切除。对于累及S(3)以上的肿瘤，为保留近乎正常的肠道和膀胱功能，需行广泛整块切除加头侧分块切除。
