Department of Surgery, E, Aarhus University Hospital, Aarhus, Denmark.
Colorectal Dis. 2012 Feb;14(2):152-6. doi: 10.1111/j.1463-1318.2011.02556.x.
Eight highly selected patients are reported, undergoing external hemipelvectomy (EHP) for malignant infiltration of the lumbosacral neural plexus.
All patients were evaluated by positron emission tomography-computed tomography (PET-CT), CT and magnetic resonance imaging. No evidence of disseminated disease was found. With agreement by the multidisciplinary team, surgery was performed by a colorectal surgeon and an orthopaedic sarcoma surgeon and, if needed, by an urologist and vascular surgeon. Patients were reconstructed with either a femoral or a gluteal musculocutaneous flap.
Of the eight women [median age 54.5 (40-68) years], two had primary carcinoma and six local recurrence of a previously treated carcinoma. R0 was possible in six patients and R1 resection in two. The median duration of hospital stay was 29.5 (17-102) days. The median follow up was 8.3 (4.7-52.8) months. Three patients have died, one from postoperative complications at 5 months and two from recurrence at 5 and 52.8 months. Phantom-limb was experienced in six patients. Four patients received a prosthesis, one is considering this and one does not want a prosthesis.
Hemipelvectomy may be considered for a highly selected group of patients with locally advanced carcinoma or recurrence involving the lumbosacral neural plexus.
报告 8 例接受腰椎骶神经丛外半骨盆切除术（EHP）治疗的恶性浸润患者。
所有患者均通过正电子发射断层扫描-计算机断层扫描（PET-CT）、CT 和磁共振成像进行评估。未发现弥散性疾病的证据。经多学科团队同意，由结直肠外科医生和骨科肉瘤外科医生进行手术，如果需要，还由泌尿科医生和血管外科医生进行手术。患者通过股或臀肌皮瓣进行重建。
8 例女性患者[中位年龄 54.5（40-68）岁]，2 例为原发性癌，6 例为先前治疗过的癌的局部复发。6 例患者可实现 R0 切除，2 例患者可实现 R1 切除。中位住院时间为 29.5（17-102）天。中位随访时间为 8.3（4.7-52.8）个月。3 例患者死亡，1 例在术后 5 个月因并发症死亡，2 例在术后 5 和 52.8 个月因复发死亡。6 例患者出现幻肢。4 例患者接受了假体，1 例正在考虑，1 例不想要假体。
对于累及腰椎骶神经丛的局部晚期癌或复发的高度选择患者，可考虑行半骨盆切除术。
