骶前发育性囊肿22例诊治经验总结

摘要

目的 总结骶前发育性囊肿的临床特点及诊治经验.方法 回顾性分析1989年1月至2008年12月收治的22例骶前发育性囊肿患者的临床资料,探讨骶前发育性囊肿的临床特点及诊治经验.结果 本组患者中,男性8例,女性14例,确诊时年龄18～72岁,中位年龄29.5岁.根据术中测量,囊肿直径(8.3±2.7)cm.包括表皮样囊肿6例,皮样囊肿4例,畸胎瘤12例(2例伴恶变).手术方式为经骶尾部入路18例,经腹手术3例,经腹-骶尾部联合入路手术1例.各术式的手术时间与出血量分别为:改良Kraske术(142±43)min/(192±149)ml,Mason术(102±27)min/(54±37)ml,经腹手术(147±25)min/(117±76)ml,1例联合入路手术为360 min/1000 ml.并发症为:骶尾部入路组术中骶前静脉丛出血1例(6.3%),术后伤口感染1例(6.3%);联合入路组术后骶尾部伤口感染1例;经腹手术组无严重并发症.术后所有患者均获得随访,平均随访40个月(9～92个月).20例良性病例中复发2例,其中经骶尾部入路1例(复发率5.9%),经腹手术1例.结论 骶前发育性囊肿虽生长缓慢,但有一定恶变风险,延迟治疗可增加日后手术切除的难度,故一经发现,应以积极、彻底的手术切除为原则.经骶尾部入路直达肿瘤部位,创伤小,并发症少,必要时可与经腹手术联合应用,是治疗骶前发育性囊肿的理想术式.%Objective To summarize the clinical features, diagnostic and therapeutic experiences of presacral developmental cysts. Methods Clinical data of 22 patients with presacral developmental cysts underwent tumor excision surgery from January 1989 to December 2008 was retrospectively analyzed. Results In this group, 8 male and 14 female patients were included with a median age of 29.5 yrs(18-72 yrs) at diagnosis. The mean diameter of the cysts was (8.3±2.7)cm. Of the cases, 6 patients presented with epidennoid cysts, 4 cases with dcrmoid cysts and 12 cases with teratomas (2 with malignant change).Surgical approaches included the transsacrococcygeal approach (18 cases), the transabdominal approach (3 cases), and the combined transabdominal-sacrococcygeal approach (1 case). The operative duration and blood loss of each operative approach was as follows: modified Kraske's procedure (142±43) min/(192±149)ml, Mason's procedure (102±27) min/(54±37) ml, transabdominal procedure (147±25) min/(117±76)ml, combined approach 360 min/1000 ml. In the transsacrococcygeal group, 1 case (6.3%) of intra-operative presacral vein bleeding and 1 case (6.3%) of the surgical incision infection occurred. One case in the combined approach group suffered from incision infection. No significant complication was found in the transabdominal group. The patients were followed up for 9-92 months (mean, 40 months) and meanwhile the tumor relapsed in 2 cases in 20 patients with benign lesions: one patient underwent transsacroccoygeal surgery and the other received transabdominal surgery. Conclusions The presacral developmental cysts develop slowly with a tendency toward malignancy. And delayed treatment brings much more difficulties to the surgical excision, so it should be radically excised once diagnosed. The transsacrococcygeal approach is a preferable surgical procedure with direct access, minimal operative injuries and complications; and the combined transabdominal-sacrococcygeal approach could be employed when needed.