Objective To investigate a new surgical approach for presacral lesion by double door via S3- 5. Methods From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feel ing in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormal ity in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size of
the lesions was 4 cm × 3 cm × 3 cm - 20 cm × 15 cm × 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S3-5. Results The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occured during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occured. During the followed-up period of 6-13 months, no sacrum defect, pelvic instabil ity and sacroil iitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. Conclusion The approach of double door via S3-5 is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.
Citation： LI Kangren,QIN Hui,LU Siwei,GUAN Jinlong,YU Bin,DENG Ning.. NEW SURGICAL APPROACH FOR PRESACRAL LESION BY DOUBLE DOOR VIA S3-5. Chinese Journal of Reparative and Reconstructive Surgery, 2009, 23(4): 412-414. doi: Copy