1Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2Surgical Outcomes Research Centre (SOuRCe), Central Sydney Area Health Service, Sydney, New South Wales, Australia 3University of Sydney, Sydney, New South Wales, Australia.
Dis Colon Rectum. 2014 Feb;57(2):272-7. doi: 10.1097/DCR.0000000000000039.
Sacrectomy is sometimes necessary to achieve negative margins in pelvic exenteration procedures. This is typically done with the patient in the prone position. Some of the limitations of the prone approach include its limited access to the lateral pelvic sidewall structures and suboptimal vascular control in comparison with the access and the vascular control of a combined abdominolithotomy approach.
This article describes a technique for performing a low sacrectomy (below the sacroiliac joint) through a transabdominal approach without the need to turn the patient prone intraoperatively.
The procedure involves 2 approaches: abdominal and perineal. The abdominal phase incorporates the complete mobilization of both lateral pelvic sidewalls and their neurovascular bundles to the intended lateral margins. The anterior margin is dependent on the extent of tumor resection necessary and may incorporate the vagina, bladder, prostate, or even part of the pubic bone. The perineal phase involves freeing all the muscular and ligamentous attachments of the posterior sacrum up to the level of S2/3. The sacrectomy is completed by using an osteotome transabdominally. It begins in the midline and extends laterally until the ischial spine and incorporates the sacrospinous through to the sacrotuberous ligaments and the whole pelvic floor.
Transabdominal low sacrectomy is technically feasible and may be associated with numerous practical advantages in comparison with a low sacrectomy performed with the patient in the prone position for involvement of the lower half of the sacrum.
在骨盆切除术手术中，为了获得阴性切缘，有时需要进行骶骨切除术。这通常在患者俯卧位时进行。俯卧位方法的一些局限性包括其对侧骨盆侧壁结构的有限可达性以及与联合腹侧切开术方法的可达性和血管控制相比，其血管控制效果不佳。
本文描述了一种通过经腹入路进行低位骶骨切除术（低于骶髂关节）的技术，无需在术中将患者转为俯卧位。
该手术涉及 2 种入路：腹部和会阴。腹部阶段包括完全游离双侧侧骨盆侧壁及其神经血管束至预期的侧缘。前边缘取决于所需的肿瘤切除范围，可能包括阴道、膀胱、前列腺，甚至部分耻骨。会阴阶段涉及游离骶骨后部的所有肌肉和韧带附着点，直至 S2/3 水平。经腹使用骨凿完成骶骨切除术。它从中线开始，并向外侧延伸，直到坐骨棘，并包括骶棘韧带，一直到骶结节韧带和整个骨盆底。
与在俯卧位下进行的低位骶骨切除术相比，经腹低位骶骨切除术在技术上是可行的，并且可能具有许多实际优势，特别是涉及骶骨下半部分时。
