Zang Jie, Guo Wei, Yang Rongli, Tang Xiaodong, Li Dasen
Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China.
J Neurosurg Spine. 2015 Jun;22(6):563-70. doi: 10.3171/2015.1.SPINE14237. Epub 2015 Mar 27.
OBJECT In this study the authors' aim was to describe their experience with total en bloc sacrectomy using a posterioronly approach and to assess the outcome of patients with malignant sacral tumors who underwent this procedure at their center. METHODS The authors identified and retrospectively reviewed the records of 10 patients with malignant sacral tumors who underwent a total en bloc sacrectomy via a single posterior approach at their center. The pathological diagnosis was chordoma in 4 patients, chondrosarcoma in 1, osteosarcoma in 1, malignant schwannoma in 1, malignant giant cell tumor in 1, and Ewing's sarcoma in 2. Radiological examination revealed that the tumor involved S1-5 in 7 patients, S1-4 in 1, S1-3 in 1, and S1-2 in 1. RESULTS All 10 patients were stable during the perioperative period. The mean surgery duration was 282 minutes (range 250-310 minutes). The median estimated blood loss was 2595 ml (range 1500-3200 ml). All patients were followed up for 13-29 months (mean 22 months). Two patients had a local recurrence. Two patients died of disease, 1 patient was alive with disease, and 7 patients were alive without evidence of disease. Among the 8 surviving patients, 6 were able to walk without assistive devices, and 2 were able to walk with crutches. The total complication rate was 40% (4 of 10). Wound complications (deep infection and wound healing problems) occurred in 3 patients, and a distal deep vein thrombosis occurred in 1 patient. CONCLUSIONS Total en bloc sacrectomy using a posterior-only approach is feasible and safe in selected patients and is an important procedure for the treatment of primary malignant tumor involving the entire sacrum or only the top portion.
在本研究中，作者的目的是描述他们采用单纯后路入路进行全骶骨整块切除术的经验，并评估在其中心接受该手术的骶骨恶性肿瘤患者的预后。方法：作者识别并回顾性分析了10例在其中心通过单一后路入路接受全骶骨整块切除术的骶骨恶性肿瘤患者的病历。病理诊断为脊索瘤4例、软骨肉瘤1例、骨肉瘤1例、恶性神经鞘瘤1例、恶性巨细胞瘤1例、尤因肉瘤2例。影像学检查显示，7例患者肿瘤累及S1 - 5，1例累及S1 - 4，1例累及S1 - 3，1例累及S1 - 2。结果：所有10例患者围手术期均平稳。平均手术时间为282分钟（范围250 - 310分钟）。估计失血量中位数为2595毫升（范围1500 - 3200毫升）。所有患者均随访13 - 29个月（平均22个月）。2例患者局部复发。2例患者死于疾病，1例带瘤生存，7例无疾病生存。在8例存活患者中，6例能够独立行走，2例需借助拐杖行走。总并发症发生率为40%（10例中的4例）。3例患者出现伤口并发症（深部感染和伤口愈合问题），1例患者发生远端深静脉血栓形成。结论：对于部分患者，采用单纯后路入路进行全骶骨整块切除术是可行且安全的，是治疗累及整个骶骨或仅骶骨顶部的原发性恶性肿瘤的重要手术。
