经肛门内镜微创手术治疗直肠肿瘤的临床疗效观察

Surgical strategy for presacral tumors: analysis of 33 cases.

机构信息

Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.

出版信息

Chin Med J (Engl). 2011 Dec;124(23):4086-91.

PMID:22340347

Abstract

BACKGROUND

Presacral tumors are highly infrequent tumors located in the space known as presacral or retrorectal space. Although there have been substantial improvements in the prognosis of patients with malignant presacral tumors, the development of newer surgical strategy is likely to further improve the oncologic outcomes of malignant presacral tumors. The aim of this article was to report our experience in 33 cases, and to review the surgical strategy, pathological features and the prevention of complications from our experience.

METHODS

A retrospective analysis was conducted on 33 cases (20 male and 13 female) with presacral tumors surgically treated in our hospital between January 1998 and April 2009. The surgical approaches included trans-abdominal in 10 cases (30%), trans-sacral in 18 cases (55%) and combined abdominal-sacral in 5 cases (15%). All patients got followed up (14 - 123 months, mean of 45.1 months). At last, the general information, clinical symptoms, histodiagnosis, surgical types and postoperative complications of all cases in our series were assessed.

RESULTS

Ages of 33 patients ranged from 18 to 71 years, with an average of 48.5 years.

PATHOLOGICAL FINDINGS

6 epidermoid cysts, 5 teratomas, 3 leiomyomas, 9 neurofibromas, 5 neurilemmomas, 1 enterogenous cyst, 1 liposarcoma, 1 leiomyosarcoma, 1 angiosarcoma, and 1 neurofibrosarcoma. All tumors were excised with no perioperative death. A colostomy was taken in one case with angiosarcoma involving the rectum because of the intraoperative injury of the rectum. Blood loss during surgery was 400 - 11 000 ml (mean of 2400 ml). Four (12%) cases had local recurrence during follow-up: 2 because of inadequate drainage after dermoidectomy, both of them were cured by surgical resection and drainage; recurrence occurred in a case of teratoma in 18 months after surgery, cured by a trans-sacral excision; local recurrence and lung metastasis occurred simultaneously in a case of angiosarcoma in 6 months postoperatively and the patient died one month later of respiratory failure.

CONCLUSIONS

The main treatment of most presacral tumors is surgical resection. Selection of surgical approach is very important for complete resection of the presacral tumors. The location, size and peculiarities of tumors, conditions of the skin and soft tissues and the patients' somatotype are all determinative factors. Multidisciplinary cooperation is also very necessary.

摘要

背景

骶前肿瘤是一种罕见的肿瘤，位于骶前或直肠后间隙。尽管恶性骶前肿瘤患者的预后有了实质性的提高，但新的手术策略的发展可能会进一步改善恶性骶前肿瘤的肿瘤学结果。本文旨在报告我们的 33 例经验，并从我们的经验中回顾手术策略、病理特征和并发症的预防。

方法

对 1998 年 1 月至 2009 年 4 月我院收治的 33 例（男 20 例，女 13 例）骶前肿瘤患者进行回顾性分析。手术途径包括经腹 10 例（30%）、经骶 18 例（55%）和腹骶联合 5 例（15%）。所有患者均获随访（14-123 个月，平均 45.1 个月）。最后，评估了我们系列中所有病例的一般信息、临床症状、组织学诊断、手术类型和术后并发症。

结果

33 例患者年龄 18-71 岁，平均 48.5 岁。

病理发现

表皮样囊肿 6 例，畸胎瘤 5 例，平滑肌瘤 3 例，神经纤维瘤 9 例，神经鞘瘤 5 例，肠源性囊肿 1 例，脂肪肉瘤 1 例，平滑肌肉瘤 1 例，血管肉瘤 1 例，神经纤维肉瘤 1 例。所有肿瘤均完整切除，无围手术期死亡。1 例血管肉瘤累及直肠，术中直肠损伤，行结肠造口术。术中出血量 400-11000ml（平均 2400ml）。随访中 4 例（12%）局部复发：2 例因皮样瘤术后引流不充分，均经手术切除和引流治愈；1 例畸胎瘤术后 18 个月复发，经骶骨切除治愈；1 例血管肉瘤术后 6 个月局部复发并肺转移，患者 1 个月后因呼吸衰竭死亡。