摘要
目的探讨骶前肿瘤的手术治疗效果及临床特点。方法回顾性分析2009年9月至2019年12月于海军军医大学附属长海医院行手术治疗的57例骶前肿瘤患者的临床资料。结果57例患者中37例行经骶入路手术,17例行经腹入路手术,2例行经腹骶联合入路手术,1例行机器人辅助腹腔镜手术,所有患者无围手术期死亡。经骶入路组手术时间、术中出血量均少于经腹入路组【90(70,120)min vs.165(130,225)min,50(20,75)mL vs.300(200,500)mL】,肿瘤直径小于经腹入路组【(41.3±17.5)mm vs.(74.9±23.2)mm】,差异均有统计学意义(均P<0.05)。57例患者出现手术并发症6例,包括骶前出血1例,切口感染3例,泌尿系统感染2例,积极治疗后均顺利出院。共检出16种病理类型,其中恶性肿瘤8例(14%)。49例良性骶前肿瘤患者最常见症状为肛门部坠胀感,共32例(占65.3%),8例恶性肿瘤患者中4例有明显的骶尾部疼痛症状。术后随访期间有5例复发。结论手术完整切除是骶前肿瘤的首选治疗方式,术前需仔细评估肿瘤情况,根据肿瘤的大小、位置及肿瘤性质选择恰当的手术路径非常关键。骶前肿瘤病理类型多样,当患者出现骶尾部疼痛症状时提示肿瘤可能发生恶变。
Objectives To investigate surgical treatment and clinical characteristics of presacral tumors.Methods This was a retrospective analysis of 57 patients with presacral tumors who received surgical treatment at Changhai Hospital,Naval Medical University between September 2009 and December 2019.Results Of the 57 patients,thirty-seven patients underwent transsacral approach,seventeen patients underwent transabdominal approach,two patients underwent a combined approach,one patient under?went robotic-assisted surgery,no death occurred in the perioperative period.Compared with transabdominal approach,transsacral approach was associated with shorter operative time[90(70,120)min vs.165(130,225)min],less intraoperative blood loss[50(20,75)mL vs.300(200,500)mL],and smaller tumors[(41.3±17.5)mm vs.(74.9±23.2)mm](P<0.05).Six complications occurred,includ?ing one presacral hemorrhage,three incision infections,two urinary tract infections.All complications resolved after active treat?ment,and all patients were discharged smoothly.There were 16 pathological types,including eight(14%)malignancies.Anal dis?tention was the most common symptom for benign presacral tumors,which was reported in 32(65.3%)out of the 49 patients.Sa?crococcygeal pain was reported in four out of the eight malignancies.Recurrence occured in 5 patients during follow-up.Conclusion Complete resection is the first choice of treatment for presacral tumors.A careful evaluation of the tumor is required be?fore surgery.It is critical to choose the appropriate approach based on the size,location,and nature of the tumor.Various patho?logical types are involved in presacral tumors.Sacrococcygeal pain is an indicator of malignancy.
作者
辛诚
王志彬
郑阔
郑楠薪
周继点
高显华
郝立强
张卫
Xin Cheng;Wang Zhibin;Zheng Kuo;Zheng Nanxin;Zhou Jidian;Gao Xianhua;Hao Liqiang;Zhang Wei(Department of Colorectal Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China;School of Basic Medical Science,Naval Medical University,Shanghai 200433,China)
出处
《结直肠肛门外科》
2020年第2期143-147,153,共6页
Journal of Colorectal & Anal Surgery
基金
国家自然科学基金(81572358)
上海市级医院新兴前沿技术联合攻关项目(SHDC12016122)。
关键词
骶前肿瘤
手术治疗
经腹入路
经骶入路
病理类型
presacral tumor
surgical approach
transabdominal approach
transsacral approach
pathological type
