Surgical Treatment of Sacral Chordomas Combined With Transcatheter Arterial Embolization
Surgical Treatment of Sacral Chordomas Combined With Transcatheter Arterial Embolization
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DOI：
10.1097/bsd.0b013e31819630ec
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发表时间：
2010-02-01
影响因子：
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通讯作者：
Tang, Tiansi
中科院分区：
文献类型：
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作者：
Yang, Huilin;Zhu, Lifan;Tang, Tiansi
研究设计：回顾性研究，分析经导管动脉栓塞术（TAE）切除骶脊索瘤的中期结果。目的：寻找一种合适的方法最大限度地切除肿瘤。背景资料摘要：虽然以前的报道已经报道了使用TAE切除肿瘤，但目前还没有使用这种方法治疗骶脊索瘤的数据。方法：选取1994年1月~ 2005年9月行手术治疗的30例骶脊索瘤患者。所有30例患者在骶脊索瘤主动脉TAE后均行后路手术。术后平均随访时间为44.6个月。回顾术中失血量、输血量和术后患者排出的血液。同时观察膀胱和肠道的括约肌功能。结果：术中出血量平均为1200 mL。患者术后平均排血量650 mL，术后平均输血量1080 mL。30例患者中12例复发，2例因肿瘤转移死亡。17例骶神经根保留在双侧S3水平及以上的患者，膀胱和肠道的括约肌功能良好，而2例仅保留在S1水平及以上的患者，括约肌功能受损。1例行结肠造口术和输尿管皮切术。结论：与历史文献相比，术前TAE切除骶骨肿瘤可显著减少术中出血量，使手术野清晰，可能无需前路入路，有利于骶骨脊索瘤的最大切除。这是一种切除骶脊索瘤的技术。
Study Design: A retrospective study, analyzing midterm results of transcatheter arterial embolization (TAE) for removal of a sacral chordoma.Objective: To develop a suitable method to maximally remove the tumor.Summary of Background Data: Although previous reports have reported the use of TAE for removal of tumors, there is currently no data available on using this method to treat sacral chordomas.Methods: Thirty patients with sacral chordomas, who underwent surgical treatment from January 1994 to September 2005, were selected. All 30 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. The average follow-up was 44.6 months after the operation. The blood lost during the operation, blood transfusion, and the blood drained from the patient after the operation was reviewed. In addition, the sphincter muscle function of the bladder and bowel was observed.Results: The intraoperative blood loss averaged 1200 mL during the removal of the tumor. The average blood drained from the patient after the operation was 650 mL. The average blood transfusion postoperatively was 1080 mL. Of the 30 patients, 12 had recurrence and 2 died of tumor metastasis. In the 17 patients whose sacral nerve roots had been bilaterally reserved at and above the S3 level, the sphincter muscle function of the bladder and bowel was good, whereas the function of the sphincter muscles was impaired in 2 patients with nerve roots reserved only at and above the S1 level. In 1 case, colostomy and ureterocutaneosomy were used.Conclusions: In comparison with historical literature, preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear, possibly eliminate the need for using an anterior approach, and facilitate the maximal removal of the sacral chordoma. It is an encouraging technique for excising the sacral chordomas.