Masterson E L, Davis A M, Wunder J S, Bell R S
University of Toronto, University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Ontario, Canada.
Clin Orthop Relat Res. 1998 May(350):187-94.
Twenty-two patients underwent hindquarter amputation with curative intent for malignant or locally aggressive tumors of the pelvis (21 cases) or proximal thigh (one case). In all cases, the ilium was resected, and in seven cases an osteotomy of the sacrum was done to achieve negative surgical margins. Only six wounds healed without complications. The worst wound problems occurred in patients requiring ligation of the common iliac vessels and in those requiring a sacral osteotomy. Twelve patients have died of disease, two are alive with extensive pulmonary metastases, and one remains well after excision of a local tumor recurrence. Thirteen of 14 patients with high grade sarcoma had metastases develop, compared with only one of eight patients with low grade sarcoma. Eight patients (all with high grade sarcoma) died within 1 year of surgery. Seven patients have remained disease free at a mean of 39 months after surgery. Given the poor prognosis and high morbidity after amputation in high grade sarcoma, the authors think that consideration should be given to pursuing nonoperative management in patients with large, high grade sarcomas and significant medical extension to the sacroiliac joint or sacrum.
22例患者因骨盆恶性肿瘤或局部侵袭性肿瘤（21例）或大腿近端肿瘤（1例）接受了根治性半骨盆截肢术。所有病例均切除了髂骨，7例进行了骶骨截骨术以获得阴性手术切缘。只有6例伤口愈合且无并发症。最严重的伤口问题发生在需要结扎髂总血管的患者以及需要进行骶骨截骨术的患者中。12例患者死于疾病，2例因广泛肺转移存活，1例在局部肿瘤复发切除后情况良好。14例高级别肉瘤患者中有13例发生转移，而8例低级别肉瘤患者中只有1例发生转移。8例患者（均为高级别肉瘤）在术后1年内死亡。7例患者术后平均39个月无疾病复发。鉴于高级别肉瘤截肢术后预后较差且发病率较高，作者认为对于患有大型高级别肉瘤且骶髂关节或骶骨有明显医学扩展的患者，应考虑采用非手术治疗。
