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目的:在有效控制出血的前提下,评价切刮术治疗骶骨骨巨细胞瘤(giant cell tumor,GCT)的临床效果。方法:自2000年7月～2007年7月我院共收治骶骨GCT患者43例。有随访记录的35例。其中男18例,女17例。年龄16～61岁,平均32岁。GCT位于S1～S5者5例,S1～S4者9例,S1～S3者12例,S1～S2者3例,S2～S5者2例;S3～S5者1例;L5～S1者3例。31例患者进行了病灶内切除术,有4例患者进行了广泛切除术。23例患者联合应用术中腹主动脉临时阻断术:其中6例采用了前路手术腹膜后分离腹主动脉阻断,17例采用了术前X线介入下腹主动脉植入球囊,术中临时阻断腹主动脉血流的方法。未行血管阻断12例。随访12个月～8年5个月,平均37个月。术后除1例患者肉瘤变后接受辅助放疗,其余均未接受辅助放疗。结果:血管阻断组平均失血量为3278ml,未行血管阻断者手术平均失血量为5150ml,两组间比较出血量差异有显著性(P<0.01)。14例患者术后出现切口并发症(40%),经过手术引流、清创后伤口愈合。7例患者术后出现不同程度的脑脊液漏,均经抬高床尾、应用抗生素等非手术治疗愈合。血管阻断组局部肿瘤复发率为30.43%(7/23),血管未阻断组复发率为66.67%(8/12),两组肿瘤复发率比较差异有显著性(P<0.05)。结论:对骶骨GCT行切刮术治疗,术中采用血管阻断技术,可以显著降低术中出血,有利于肿瘤的彻底切除并降低术后复发率。
OBJECTIVE: To evaluate the clinical effect of scalpel surgery for giant cell tumor (GCT) on the premise of effective control of bleeding. Methods: From July 2000 to July 2007, 43 patients with sacral GCT were treated in our hospital. Follow-up records of 35 cases. There were 18 males and 17 females. Age 16 to 61 years old, average 32 years old. There were 5 patients with GCT in S1 ~ S5, 9 patients with S1 ~ S4, 12 patients with S1 ~ S3, 3 patients with S1 ~ S2, 2 patients with S2 ~ S5, 1 patient with S3 ~ S5, 3 patients with L5 ~ S1 . Thirty-one patients underwent endorectomy and four patients underwent extensive excision. Twenty-three patients underwent temporary occlusion of the abdominal aorta during surgery: six of them underwent anterior resection of the abdominal aorta with retroperitoneal isolation, and 17 underwent preoperative X-ray insertion of the lower abdominal aorta, Temporary blocking of abdominal aorta blood flow method. No vascular occlusion in 12 cases. Follow-up 12 months to 8 years and 5 months, an average of 37 months. All patients received adjuvant radiotherapy after one patient had sarcoidosis, and the rest did not receive adjuvant radiotherapy. Results: The average blood loss in the vascular block group was 3278ml. The average blood loss in the non-vascular blocker group was 5150ml. There was significant difference between the two groups in bleeding volume (P <0.01). Fourteen patients had postoperative complications of incision (40%). After surgical drainage, the wounds healed after debridement. Seven patients had different degrees of postoperative cerebrospinal fluid leakage, elevated bed tail, the application of antibiotics and other non-surgical treatment of healing. The recurrence rate of local tumor was 30.43% (7/23) in vascular occlusion group and 66.67% (8/12) in non-occluded group. There was significant difference between the two groups (P <0.05). Conclusion: The curative resection of sacral GCT and intraoperative vascular occlusion technique can significantly reduce intraoperative bleeding, which is conducive to the complete resection of the tumor and reduce the recurrence rate.