原発性仙骨腫瘍に対する手術治療の成績と問題点

Results of Surgical Treatment of Primary Tumors of the Sacrum

　抄録：原発性仙骨腫瘍手術例21例の臨床成績について調査した．脊索腫9例，巨細胞腫5例，神経鞘腫4例，軟骨肉腫2例，ユーイング肉腫1例であった．脊索腫では仙骨全摘・再建を2例に，仙骨切断を7例に行ったが，後者では全7例で再発を認めた．巨細胞腫は掻爬を4例，仙骨切断を1例に行い，4例で再発を生じ，再手術を要した．脊索腫2例と軟骨肉腫の1例が腫瘍死し，その他の症例は生存していた．合併症は感染，難治性下肢痛が各5例，instrumentation failure 2例などであり，排尿障害は76％に認めた．本腫瘍は治療法の選択，合併症対策など今後解決すべき様々な問題がある．

　The results of surgical treatment of 21 cases of primary tumors of the sacrum were investigated. The consisted of nine chordomas, five giant cell tumors (GCT), four schwannomas, two chondrosarcomas, and one Ewing sarcoma. Total sacrectomy and reconstruction was performed in two of the cases of chordoma, and sacral amputation in the other seven, and local recurrence developed in all seven cases. Curettage was performed in four cases of GCT, and sacral amputation in the remaining case. Four of the five operations for GCT were followed by recurrence, and re-operation was performed. As of the final follow-up, three patients had died of their disease, five were alive with disease, and the remaining 13 patients had no evidence of disease. Complications included infection and intractable leg pain in five patients each and instrumentation failure in two. Urinary disturbance was observed postoperatively in 76％of the patients. Thus, a variety of problems remain be solved in the treatment of primary tumors of the sacrum.