Gitsch G, Jensen D N, Hacker N F
Department of Gynecology and Obstetrics, University of Vienna, Austria.
Gynecol Oncol. 1995 Apr;57(1):113-6. doi: 10.1006/gyno.1995.1107.
We describe the case of a 24-year-old woman with a giant cell tumor originating from the distal part of the sacrum, which was almost completely filling the pelvis and extending to the umbilicus. At laparotomy, the tumor was separated from all of the pelvic structures including the ureters. The sigmoid colon was transected and the tumor was dissected down to the pelvic floor. A separate perineal incision was made, the rectovaginal septum was entered, and the posterior vaginal wall was bisected to give better access. It was possible to mobilize the tumor completely after dividing the rectum 5 cm from the anus. All macroscopic tumor was removed in continuity with the sigmoid colon. The ovaries were transposed to the paracolic gutter to avoid artificial menopause following radiation therapy. A sigmoid colostomy was formed. Because histology could not provide definite evidence of complete removal of the tumor, radiation therapy to the sacrum was given. Forty-two months after her surgery, the woman remains free of disease. The abdominoperineal approach should be considered for patients with a large tumor which is fixed to the sacrum.
我们描述了一名24岁女性的病例，其骶骨远端起源的巨细胞瘤几乎完全充满盆腔并延伸至脐部。在剖腹手术中，肿瘤与包括输尿管在内的所有盆腔结构分离。乙状结肠被横断，肿瘤被向下解剖至盆底。做了一个单独的会阴切口，进入直肠阴道隔，将阴道后壁一分为二以获得更好的暴露。在距肛门5厘米处切断直肠后，有可能将肿瘤完全游离。所有肉眼可见的肿瘤连同乙状结肠一并完整切除。卵巢被移位至结肠旁沟，以避免放疗后出现人工绝经。形成了乙状结肠造口术。由于组织学检查无法提供肿瘤完全切除的明确证据，因此对骶骨进行了放疗。手术后42个月，该女性仍无疾病复发。对于肿瘤较大且与骶骨固定的患者，应考虑采用腹会阴联合入路。
