Watkins R M, Thomas J M
Westminster Hospital, London, UK.
Br J Surg. 1987 Aug;74(8):711-4. doi: 10.1002/bjs.1800740821.
Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. Buttock tumours which had passed through the greater sciatic notch to become palpable on pelvic examination were also considered likely to be inoperable. On computed tomographic (CT) examination, tumours were considered inoperable if the psoas muscle was involved above the inguinal ligament, or if malignant disease involved the sacro-iliac joint, sacrum or perineal structures. Soft tissue tumours of the buttock extending significantly through the greater sciatic notch were also considered likely to be inoperable. Five patients thought suitable for hindquarter amputation on clinical assessment had no excluding features on CT; four undergoing hindquarter amputation were proven on histological examination to have good clearance of their tumours. In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.
9例软组织肉瘤靠近骨盆带，1例骨盆原发性恶性骨肿瘤患者被转诊考虑行半侧骨盆截肢术。如果恶性疾病浸润至会阴或穿过骶髂关节，则根据临床情况认为患者不适合行半侧骨盆截肢术。如果股三角区的疾病延伸至腹股沟韧带上方，则肿瘤的可切除性受到严重质疑。通过坐骨大孔穿出并在盆腔检查时可触及的臀部肿瘤也被认为可能无法手术切除。在计算机断层扫描（CT）检查中，如果腰大肌在腹股沟韧带上方受累，或者恶性疾病累及骶髂关节、骶骨或会阴结构，则肿瘤被认为无法手术切除。显著穿过坐骨大孔的臀部软组织肿瘤也被认为可能无法手术切除。5例经临床评估认为适合行半侧骨盆截肢术的患者在CT上没有排除特征；4例行半侧骨盆截肢术的患者经组织学检查证实肿瘤切除彻底。在另一例经临床评估认为适合行半侧骨盆截肢术的患者中，CT显示肿瘤整块广泛切除可行，从而能够保留患肢。4例经临床检查被认为不适合行半侧骨盆截肢术的患者，在所有病例中CT均证实无法手术切除。CT补充了临床检查，并为选择半侧骨盆截肢术患者提供了一种客观可靠的方法，应避免不必要的手术探查。
