30Cases Of Surgical Treatment Of Sacral Chordoma Were Retrospectively Analyzed And Experience

Objective:to retrospective analysis and discuss the effect of surgical treatment of sacral chordoma and experience summary.Methods:retrospective in January2004-November2011in the undergraduate course room is given priority to with surgical treatment, and a complete follow-up records of the clinical data of30patients with sacral chordoma.All women in patients with male18cases,12cases, patients with an average age of49.1years (39-68).Among them9cases in the outer court or we received surgical treatment, postoperative recurrence, added to our line again surgery and radiation therapy and other comprehensive treatment.The extent of erosion under the S3segment and its low chordoma for20cases, assault and S2and above the range of10cases of chordoma is high.To pre-hospital patients have different degree of discomfort, features a progression, time range between1to4years.22cases with lumbar or sacral tail pain, some with radiation pain to the hips and the perineum,4cases of patients with lower limb weakness symptoms.Nine patients appear the symptom of dysuria,7cases of patients with symptoms of constipation.There are17patients through the anus refers to the inspection before touch the sacral neoplasm, fixed position.All patients according to imaging data, medical history, location and age can make a preliminary diagnosis.2cases for biopsy in diagnosis, and the rest for postoperative pathologic specimens confirmed.For this group of chordoma in7cases of preoperative within24h adept bilateral iliac artery embolization, by the simple back into the road surgery under general anesthesia.The extent of erosion under the S3for9cases, choice of extensive tumor resection, resection S4and S5nerve root, along with all the abuse and S3and the above range for21cases, select the edge or the cyst excision, carefully check the cut edge, remove residual lesions, as far as possible keep S1and S2nerve root and unilateral S3nerve root.2patients with preoperative biopsy, complete excision biopsy channel along with.Through the careful preoperative data for each patient, summarized preoperative preparation, surgical methods and process, effects, and presence of complications after surgery.Clinical data analysis of the advantages and disadvantages of the surgical procedure and the effect of gain and loss, imaging data comparison before and after operation and postoperative complications, etc.Results:all patients with an average follow-up time of about48months.Postoperative clinical symptoms related partial or complete remission rate reached more than90%.In9cases of tumor erosion area under the S3patients, all rows wide excision, excision of sacral4and5sacral nerve roots at the same time, because retained the lateral sacral3above nerve root, so patients did not see obvious sphincter dysfunction, big, no obvious abnormal urination function, bilateral lower limb motor function without exception.In2cases save only unilateral lumbosacral above3patients with nerve root, no obvious dysfunction in1case,1case of postoperative symptoms of sphincter function decline, after symptomatic treatment and rehabilitation exercise, the function returned to normal after2months.Only save the sacral nerve root more than2,9cases with rectum and bladder sphincter dysfunction, constipation and dysuria, recoverable after half a year.Resection patients with unilateral s1nerve root, at least in ipsilateral lower limb walking function is impaired, but with the aid of crutches to walk, such as big, urinate damaged need long urethral catheterization, regular bowel care.Have5cases require surgery incision drainage, debridement, dressing change for a long time, phase ii small incisions.2cases because of the high cut edge skin tension, defect is big, need to repair suture line glutes myocutaneous flap.Because are near the perineum area, postoperative incision infection,2cases with an anti-inflammatory, and regular treatment symptomatic treatment, primary healing of incision.1patients postoperative complications of cerebrospinal fluid leakage, to push up the end of the bed, dressing and anti-inflammatory treatment regularly, strengthen the nursing, primary healing of incision.The average bleeding of about1350ml (300ml-4000ml), no intraoperative death cases.After4patients died within five years, the death rate was13.3%, the recurrence cases for10cases, the recurrence rate was33.3%, among them3cases of secondary relapse,4cases of recurrence of three times.An average of five years after surgery and radiotherapy5-year survival rate reached86.7%.Conclusion:for both initial and recurrent tumors, and the body conditions allow, with surgical treatment is given priority to, at the same time merge complementary radiotherapy combined with comprehensive treatment, is the effective method for the treatment of sacral chordoma.