Chretien P A, Sugarbaker P H
Surgery. 1981 Nov;90(5):900-9.
Hemipelvectomy is most frequently indicated for sarcoma of the upper thigh, hip, or pelvis. With the patient in the lateral position the incision is made through the anterior abdominal wall, and the iliac vessels are dissected free and divided just distal to the aortic bifurcation. The multiple visceral branches of the internal iliac vessels are divided and ligated to expose the sacral nerve roots deep within the pelvis. The posterior skin flap is dissected free and the gluteus maximus muscle severed from its origin on the sacrum. Back muscles are detached from the wing of the ilium and the psoas muscle with accompanying obturator and femoral nerves is divided. The pelvis begins to open as the symphysis pubis is divided. Next the sacral nerve roots are divided and anterior capsule of the sacroiliac joint. The muscles and ligaments of the pelvic floor are severed including the urogenital diaphragm, levator ani muscle, sacrotuberous ligament, and sacrospinalis ligament. The specimen is released by severing the sacroiliac joint posteriorly. The operative defect is closed by suturing gluteal fascia to inguinal ligament over suction drains.
半骨盆切除术最常用于治疗大腿上段、髋部或骨盆的肉瘤。患者取侧卧位，经前腹壁做切口，游离并切断髂血管，在主动脉分叉远端进行。切断并结扎髂内血管的多个内脏分支，以暴露盆腔深处的骶神经根。游离后皮瓣，从骶骨起点处切断臀大肌。将背部肌肉从髂骨翼分离，切断腰大肌及其伴行的闭孔神经和股神经。切断耻骨联合后，骨盆开始打开。接着切断骶神经根和骶髂关节前囊。切断盆底的肌肉和韧带，包括尿生殖膈、肛提肌、骶结节韧带和骶棘韧带。通过切断骶髂关节后方来取出标本。通过将臀筋膜缝合到腹股沟韧带上并放置负压引流管来闭合手术缺损。
