摘要
目的:探讨腹腔镜辅助下双侧髂内动脉结扎、骶骨瘤体前方组织分离、后路切除高位骶骨肿瘤的可行性。方法:2002年1月至2005年10月采用腹腔镜辅助下双侧髂内动脉结扎、骶骨肿瘤前方组织分离后行后路瘤体切除治疗高位骶骨肿瘤患者11例,男8例,女3例,年龄23￣49岁;骨巨细胞4例,脊索瘤4例,神经鞘瘤3例。6例肿瘤累及到S1椎体,5例累及到S2椎体,瘤体均侵犯骶前组织。结果:所有患者肿瘤均被顺利切除,术中未出现不可控制的出血,出血量500～1900ml,平均800ml;术后第2天患者恢复肠道排气并进食,未出现腹部并发症。9例切除或部分切除骶髂关节的患者进行了腰骶重建,同时行腰椎横突与髂骨间的植骨融合。随访3～25个月,平均11个月,随访期间未出现肿瘤复发,内固定无松动,植骨融合良好。结论:腹腔镜辅助下双侧髂内动脉结扎、瘤体前方组织分离后行后路骶骨肿瘤切除能明显减少手术出血及瘤体切除的难度,腹部手术创伤小,是切除侵犯骶前组织高位骶骨肿瘤的有效手术方式。
Objective：To study the feasibility of laparoseope assist excision of sacral tumor by means of ligating the both sides internal iliae artery and dissecting the soft tissue over the tumor anteriorly,and excising the high level sacral tumor mass posteriorly.Method：Eleven patients who underwent excision of sacral tumor after both sides internal lilac artery ligation and tissue dissection under the assistant of laparoseope during 2002 to 2005 were foliowed-up.8 were males,and 3 were females.4 cases were giant eell tumor of bone,4 cases were ehordoma and 3 cases were nerve sheath tumors.Tumor mass was located at the high level of sacrum in all the eases,Sl was involved in 6 eases,S2 was involved in 5 eases.Soft tissue over the sacrum was involved by the tumor in all eases.Result：Sacral tumor was excised successfully in all cases. The average blood loss was 800ml（500-1900ml）.For all the patients,Gastrointestinal function was recovered in 2 clays after surgery and food-taking started at that time.No complication related to abdomen was found. Lumbosaeral reestablishment and bone grafting between transverse process of lumbar vertebra and ilium were performed in 9 patients,whose sacroiliac joint was completely or partially reseeted.All the patients were followed up 3-25 months ,averaged 11 months.There was no tumor recurrence was found during the follow-up. No internal fixation failure.Good bone fusion noted.Conclusion：Laparoscope assist excision of sacral tumor,by means of ligating the both sides internal iliae artery and dissecting the soft tissue over the tumor anteriorly, and excising the high level sacral tumor mass posteriorly,is an effective operation method for sacral tumor surgery,which have the advantages that not only decreasing the operative blood and difficulty of surgery,but also diminishing the operation wound at the belly side.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第5期349-351,共3页
Chinese Journal of Spine and Spinal Cord
关键词
骶骨肿瘤
手术
腹腔镜
髂内动脉结扎
Sacrum tumor
Operation
Laparoseope
Hypogastrie artery ligation
作者简介
初同伟：男（1966-），医学博士，副主任医师、副教授，硕士研究生导师．研究方向：脊柱外科电话：（023）68774080 E—mail：chtw@sina．com
