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论 著 明胶海绵靶血管栓塞后手术治疗原发性骶骨肿瘤 135 重点学科基金资助项目（RC2003091） 作者单位： 215006 江苏 苏州大学附属第一医院 骨科 第一作者：杨惠林，男，江苏吴江，主任医师教授博导，博士【摘要】 目的 探讨明胶海绵靶血管栓塞后手术治疗骶骨脊索瘤与骶骨巨细胞瘤的临床疗效。 方法 收集1994年1月2008年1月靶血管栓塞后手术治疗61例原发性骶骨肿瘤患者的临床资料，对资料完整的35例骶骨脊髓瘤与11例骨巨细胞瘤进行回顾性研究。所有患者术前均用明胶海绵进行靶血管栓塞，栓塞后平均1.5 d内后方入路手术切除肿瘤。记录术中出血量与输血量，并观察大小便功能和肿瘤复发情况。 结果 所有患者瘤体均顺利切除，术中出血平均1 230 m(200～5100 m)，平均输血量1 000 m(0～4 200 m)。平均随访53.6个月（8～156个月），脊髓瘤患者复发11例（31.4%），其中死亡5例（14.3%），骨巨细胞瘤复发1例（9.1%）。保留双侧S13神经根或保留双侧S12神经根及一侧S3神经根者术后大小便功能基本正常，余均有不同程度的大小便功能障碍。结论明胶海绵靶血管栓塞后手术治疗原发性骶骨肿瘤，可有效减少术中出血，增加肿瘤切除率和彻底切除的可能性；对肿瘤较大的患者后方入路仍能较好完成手术，疗效满意。 【关键词】骶骨；脊髓瘤；骨巨细胞瘤；手术；栓塞Surgical Treatment of Sacral primartumors After Transcatheter Arterial Embolization with gelfoam YANG Hui-lin, WANG Gen-lin, ZHU Li-fan, CHEN Kang-wu, WANG Bin, LU Jian, JI Yi-ming, TANG Tian-si. Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China Supported by the 135 Foundation of Jiangsu Province (RC2003091) Corresponding Authors：YANG Hui-lin, E-mail： 【Abstract】Objective To study the clinical efficacy of surgical treatment for sacral chordoma and bone giant cell tumors. Methods The data of 35 patients with sacral chordomas and 11 patients with bone giant cell tumors treated by operation in our hospital from January 1994 to January 2008 were retrospectively studied. All the cases were operated with posterior approach within average 36 hours after transcatheter arterial embolization with gelfoam. The blood loss and blood transfusion during operation were reviewed. The sphincter muscle function of bladder and bowl, and tumor recurrence were observed. Results The blood loss was ranging from 200 ml to 5100 ml (average 1230 ml). The blood transfusion was ranging from 0 ml to 4200 ml (average 1000 ml). All the cases were followed for an average of 53.6 months (range 8 to 156 months). At the final follow-up, 11 of 35 chordomas recurred (31.4%) and 5 cases died of tumor (14.3%). 1 of 11 bone giant cell tumors recurred (9.1%) and