北京大学学报(医学版) ›› 2018, Vol. 50 ›› Issue (6): 1049-1052. doi: 10.19723/j.issn.1671-167X.2018.06.019

• 论著 • 上一篇    下一篇

人工韧带在耻骨肿瘤切除后重建下腹壁缺损中的应用

臧杰,郭卫(),汤小东,曲华毅,李大森   

  1. 北京大学人民医院骨与软组织肿瘤治疗中心, 北京 100044
  • 收稿日期:2018-08-19 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 郭卫 E-mail:bonetumor@163.com

Application of artificial ligament in treatment of lower abdominal wall reconstruction after pubic tumor resection

Jie ZANG,Wei GUO(),Xiao-dong TANG,Hua-yi QU,Da-sen LI   

  1. Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-08-19 Online:2018-12-18 Published:2018-12-18
  • Contact: Wei GUO E-mail:bonetumor@163.com

摘要:

目的: 从患者的主观角度和临床客观指标评价人工韧带用于耻骨肿瘤切除后重建的临床效果。方法: 选择2012年2月至2018年2月因耻骨肿瘤就诊于北京大学人民医院骨与软组织肿瘤治疗中心,并接受手术切除和人工韧带重建的25例患者进行回顾性分析,评价其临床疗效以及相关并发症。结果: 所有患者均顺利接受手术,单纯切除耻骨上支的患者8例,耻骨下支5例,耻骨上下支一并切除的12例。平均出血量(774±580) mL,平均手术时间(138±25) min,平均住院时间(19±6) d。1例患者术后出现伤口愈合问题,经清创后愈合。平均随访时间为(37±21)个月,肿瘤复发1例,1例转移癌(肾癌)患者因原发肿瘤进展而死亡。无切口疝,无韧带感染以及局部异物感等相关并发症。23例患者术后活动不需要借助任何辅助设施,2例患者活动时需要拄单拐。19例患者未诉任何疼痛不适,3例患者诉活动时感轻度疼痛,3例患者中度疼痛。评价术后功能的MSTS评分平均为87±4。结论: 人工韧带可应用于耻骨肿瘤切除后下腹壁缺损的重建,此重建方式可以预防腹壁疝的发生,同时可以通过减小残腔而降低术后感染的发生率,从而获得患者术后较好的主观评价。

关键词: 耻骨肿瘤, 骨盆肿瘤, 人工韧带, 腹壁重建,

Abstract:

Objective: For patients who had hemipelvectomies involving the resection of a portion or the whole of the pubis, bony reconstruction was not recommended commonly. However, the soft tissue reconstruction of the lower abdominal wall may benefit these patients. The object of the study was to determine the clinical effect of lower abdominal wall reconstruction with LARS ligament after pubic tumor resection interms of patient-reported and objective outcome.Methods:In this series, we reviewed twenty-five patients who underwent pubic tumor resection followed by reconstruction with LARS ligament between February 2012 and February 2018 retrospectively. We evaluated the clinical outcome and complication of this surgical treatment. The function outcome was evaluated according the musculoskeletal tumor society scores (MSTS) for all the patients at the end of the last follow-up.Results:All the patients were stable during the surgery. There were eight patients who underwent resection of superior ramus of pubis, five patients who had resection of inferior ramus of pubis, and twelve patients who received both superior and inferior ramus of pubis. For all the patients, the mean blood loss was (774±580) mL. The mean operation time was (138±25) min. The mean hospital stay was (19±6) d. For the patients who had resection of superior ramus, inferior ramus, as well as both superior and inferior ramus, the mean blood loss were (763±802) mL, (730±315) mL and (808±485) mL, respectively. The mean operation time were (133±27) min, (135±35) min and (143±20) min, respectively. The mean hospital stay were (18±5) d, (22±9) d and (19±6) d, respectively. The mean follow-up time was (37±21) months. Local recurrence was observed in one patient with chondrosarcoma. One patient with renal cancer metastasis died of the disease. No ligament infection, ligament related complication and incisional hernias were observed. Twenty-three patients could ambulate without assistive devices, and the remaining two could walk by crutches. Postoperative pain was reported as none in nineteen patients, mild in three, and mod-erate in three. From a functional point, the mean MSTS score was 87±4.Conclusion:Lower abdominal wall reconstruction with LARS ligament after pubic tumor resection could have satisfactory clinical outcome. It could prevent the occurrence of herniation, decrease the infection rate by minishing the dead space, and achieve good patient-reported outcome.

Key words: Pubic tumor, Pelvic tumor, Artificial ligament, Abdominal wall reconstruction, Hernia

中图分类号: 

  • R738.1

图1

骨盆X线平片"

图2

骨盆CT"

图3

术中肿瘤完整切除后局部术野"

图4

术中重建后的手术野"

图5

术后即刻骨盆X线平片"

表1

手术及功能预后情况"

Location Superior ramus (n=8) Inferior ramus (n =5) Superior and inferior ramus (n =12) Total (n =25) P
Mean blood loss/mL 763±802 730±315 808±485 774±580 0.965
Mean operation time/min 133±27 135±35 143±20 138±25 0.619
Mean hospital stay/d 18±5 22±9 19±6 19±6 0.579
Mean MSTS scores 84±7 89±3 88±3 87±4 0.099

图6

K-M生存曲线显示术后患者的总体生存情况"

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