盆腔腹膜外软组织肿瘤的手术治疗策略

目的 探讨盆腔腹膜外软组织肿瘤恰当的手术入路及手术方法.方法 2007年4月至2011年1月收治14例盆腔腹膜外软组织肿瘤患者.男5例,女9例.平均年龄51岁（15～66岁）.恶纤组3例、转移瘤2例、黏液炎性纤维母细胞肉瘤1例;硬纤维瘤3例、神经鞘瘤2例,畸胎瘤、表皮样囊肿、孤立性纤维性肿瘤各1例.6例肿瘤局限于坐骨大孔,采用后侧入路.2例肿瘤位于坐骨大孔处,但肿瘤较大者,采用前后联合入路.2例肿瘤位于耻骨后方,采用前方经耻骨下支入路,切除部分耻骨下支.4例肿瘤位于骶骨前方,采用后侧入路,切除部分骶骨.结果 6例恶性肿瘤均行边缘性切除,1例硬纤维瘤患者行分块切除,1例患者术中损伤阴道,行修补术,其余13例术中未损伤盆腔脏器.术后随访6-50个月,良性肿瘤患者中1例硬纤维瘤术后复发;恶性肿瘤患者中无瘤生存1例.结论 盆腔腹膜外软组织肿瘤可发生于盆腔腹膜外任何部位,肿瘤的切除可根据肿瘤生长的部位及大小决定手术入路.

Strategy of surgical treatment for soft tissue tumors of the pelvic extraperitoneal spaces

Objective To investigate the appropriate surgical approach and operative method of the treatment for soft tissue tumors of the pelvic extraperitoneal spaces. Methods From April 2007 to January 2011, 14 patients with soft tissue tumors of the pelvic extraperitoneal spaces were adopted. There were 5 males and 9 females, with an average age of 51 years old （range; 15-66 years）. Classifications of the tumors were as follows： 3 cases of malignant fibrous histiocytoma, 2 cases of metastasis tumors, 1 case of myxoinflammatory fibroblastic sarcoma; 3 cases of desmoid tumors, 2 cases of schwannoma, 1 case of teratoma, epidermoid cyst and solitary fibrous tumors respectively. 6 out of the patients whose tumors were located in the greater sciatic foramen were treated surgically by posterior approach, and 2 out of them, whose tumors were much bigger, were treated by combined anterior and posterior approach. 2 patients whose tumors were located behind the pubis were treated surgically by anterior approach through the inferior pubic ramus and part of the inferior pubic ramus was excised. 4 patients whose tumors were located in front of the sacrum were treated by posterior approach and part of the sacrum was excised. Results 6 patients with malignant tumors were treated with marginal resection. 1 patient with desmoid tumors was treated with segmental resection. 1 patient with vagina injuries during surgery underwent repair. No pelvic viscera injury was found in the remaining 13 patients. The postoperative follow-up time was from 6 to 50 months. 1 patient with desmoid tumors among the patients with benign tumors had recurrence postoperatively. 1 patient among patients with malignant tumors survived without tumors. Conclusions The soft tissue tumors of the pelvic extraperitoneal spaces may be located in any site of the pelvic extraperitoneal spaces. The surgical approach for tumor resection can be chosen according to the location and size of the tumors.