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本文介绍1例巨大骶骨骨巨细胞瘤患者的多学科诊治过程。患者男性,24岁,因大便困难4个月,加重伴小便困难1周收治入院。骨盆影像学检查提示骶3以下椎体椎前巨大囊实性肿块,大小约16.1 cm×11.5 cm×15.4 cm,行病灶CT引导下穿刺活检病理报告示骶骨巨细胞瘤。临床分期为CampanacciⅢ期,初诊时骶骨肿瘤巨大,无法通过一期手术进行切除。经过多学科讨论后患者接受血管外科多次骶骨肿瘤血管栓塞术,在全麻下行腹主动脉球囊阻断下前后联合入路骶骨肿瘤切除内固定术,最终实现前后路的肿瘤切除。1年后开始行局部放疗,方案为设骶骨瘤区按D95包计划靶区(planning target volume,PTV)6 MV-X线DT45 Gy/24 F适形放疗。放疗24次。随访至术后26个月,患者KPS评分从术前的60分提高至90分,大小便功能基本正常,双下肢活动正常,日常生活基本满意。骨肿瘤(尤其是巨大的骶骨肿瘤)的多学科诊治具有重要意义,多学科诊治团队需常态化和专业化以实现患者的最大获益。
This article describes a case of giant sacral giant cell tumor in patients with multidisciplinary diagnosis and treatment process. Male patient, 24 years old, due to stool for 4 months, aggravated with urination 1 week admitted to hospital. Pelvic imaging examination showed sacral 3 vertebral anterior vertebral huge cystic mass, size of about 16.1 cm × 11.5 cm × 15.4 cm, CT guided lesions under the guidance of biopsy biopsy showed sacral giant cell tumor. The clinical stage was Campanacci III. The sacral tumor was huge at the time of first visit and could not be surgically removed. After multidisciplinary discussion, patients underwent multiple sacral tumor vascular embolizations in vascular surgery and underwent general anesthesia with sacral tumor resection and internal fixation under anterior and posterior abdominal aortic balloon occlusion. Tumor resection was finally achieved. One year later, local radiotherapy was started. The program consisted of setting 6 MV-X DT45 Gy / 24 F conformal radiotherapy in the sacral tumor area according to D95 planning target volume (PTV). Radiation 24 times. Followed up to 26 months after operation, the KPS score increased from 60 to 90 before surgery, with normal urination and defecation, normal activities of both lower extremities, and satisfactory general daily life. Multidisciplinary diagnosis and treatment of bone tumors (especially giant sacral tumors) is of great importance and multidisciplinary teams need to be normalized and specialized to maximize patient benefit.