• 1.四川大學(xué)華西醫(yī)院肝臟及血管外科(四川成都 610041);;
  • 2.四川大學(xué)華西醫(yī)院骨科(四川成都 610041);

目的探討應(yīng)用低位腹主動(dòng)脈內(nèi)球囊阻斷技術(shù)在骨盆或骶骨腫瘤切除術(shù)中的臨床應(yīng)用價(jià)值。方法 2006年4月至2010年4月期間我院應(yīng)用低位腹主動(dòng)脈內(nèi)球囊阻斷技術(shù)控制24例骨盆和骶骨腫瘤手術(shù)過(guò)程中的出血。術(shù)中先用球囊導(dǎo)管阻斷低位腹主動(dòng)脈，每次阻斷腹主動(dòng)脈60 min，若超過(guò)60 min間隔10～15 min后再阻斷，然后再行腫瘤切除。結(jié)果本組患者平均手術(shù)時(shí)間為153 min (40~245 min); 阻斷低位腹主動(dòng)脈后，手術(shù)中平均出血為310 ml (200~650 ml)，手術(shù)野干凈，解剖清晰，腫瘤周圍的血管、神經(jīng)以及盆腔器官明確，腫瘤邊界容易確定，腫瘤被完整切除，腫瘤的術(shù)野污染小。手術(shù)全過(guò)程中，患者血壓穩(wěn)定，術(shù)后患者腎功能及盆腔器官均正常。1例患者發(fā)生穿刺側(cè)髂動(dòng)脈血栓形成，通過(guò)Fogarty取栓導(dǎo)管取出血栓后下肢血供恢復(fù)，術(shù)后無(wú)缺血癥狀，其余患者雙下肢均正常，無(wú)并發(fā)癥發(fā)生。結(jié)論應(yīng)用低位腹主動(dòng)脈內(nèi)球囊阻斷技術(shù)切除骨盆和骶骨腫瘤可有效減少術(shù)中出血，提高手術(shù)的安全性和完整切除率，是一項(xiàng)具有實(shí)用價(jià)值的臨床技術(shù)。

引用本文： 黃斌,趙紀(jì)春,馬玉奎,屠重棋,段宏. 低位腹主動(dòng)脈內(nèi)球囊阻斷技術(shù)在骨盆和骶骨腫瘤切除術(shù)中的應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(6): 635-638. doi: 復(fù)制

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2. Turcotte RE, Sim FH, Unni KK. Giant cell tumor of the sacrum [J]. Clin Orthop Relat Res, 1993, (291): 215221.
3. 李鼎鋒, 崔秋, 樂(lè)守玉, 等. 腹主動(dòng)脈血流阻斷技術(shù)在行骨盆、骶骨腫瘤切除中的臨床評(píng)價(jià) [J]. 中國(guó)癌癥雜志, 2003, 13(3): 259262.
4. Simpson AH, Porter A, Davis A, et al. Cephalad sacral resection with a combined extended ilioinguinal and posterior approach [J]. J Bone Joint Surg Am, 1995, 77(3): 405411.
5. 北京大學(xué)人民醫(yī)院骨與軟組織腫瘤治療中心. 骶骨腫瘤的手術(shù)治療 [C]. 北京: 北京國(guó)際骨與軟組織腫瘤研討會(huì), 2003: 28.
6. Ozaki T, Liljenqvist U, Halm H, et al. Giant cell tumor of the spine [J]. Clin Orthop Relat Res, 2002, (401): 194201.
7. Salai M, Garniek A, Rubinstein Z, et al. Preoperative angiography and embolization of large pelvic tumors [J]. J Surg Oncol, 1999, 70(1): 4144.
8. Wirbel RJ, Roth R, Schulte M, et al. Preoperative embolization in spinal and pelvic metastases [J]. J Orthop Sci, 2005, 10(3): 253257.
9. Chatziioannou AN, Johnson ME, Pneumaticos SG, et al. Preoperative embolization of bone metastases from renal cell carcinoma [J]. Eur Radiol, 2000, 10(4): 593596.
10. 梁斌, 韋敏克, 李宏宇, 等. 動(dòng)脈栓塞對(duì)骨盆腫瘤手術(shù)療效的影響 [J]. 中國(guó)矯形外科雜志, 2006, 14(11): 831833.
11. Wuisman P, Lieshout O, Sugihara S, et al. Total sacrectomy and reconstruction: oncologic and functional outcome [J]. Clin Orthop Relat Res, 2000, (381): 192203.
12. Lackman RD, Khoury LD, Esmail A, et al. The treatment of sacral giantcell tumours by serial arterial embolisation [J]. J Bone Joint Surg Br, 2002, 84(6): 873877.
13. Lin PP, Guzel VB, Moura MF, et al. Longterm followup of patients with giant cell tumor of the sacrum treated with selective arterial embolization [J]. Cancer, 2002, 95(6): 13171325.
14. O’Donnell ME, Badger SA, Makar RR, et al. Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms [J]. J Vasc Surg, 2006, 44(1): 211215.
15. Mi C, Lu H, Liu H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases [J]. Spine (Phila Pa 1976), 2005, 30(20): E614E616.
16. Rutherford R. Vascular surgery [M]. Philadelphia: Saunders, 2000: 959970.
17. Ullmark G, Hovelius L, Strindberg L, et al. Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery [J]. Acta Orthop Scand, 2000, 71(1): 5154.
18. 潘水章, 何登偉. 低位腹主動(dòng)脈間歇性阻斷技術(shù)的臨床應(yīng)用 [J]. 臨床骨科雜志, 2000, 3(3): 183184.
19. Silberzweig JE, Marin ML, Hollier LH, et al. Balloonexpandable common iliac artery occluder device for endovascular aneurysm repair [J]. Vasc Surg, 2001, 35(4): 263271.
20. 唐順, 董森, 郭衛(wèi), 等. 腹主動(dòng)脈球囊阻斷控制骶骨腫瘤切除術(shù)中出血的效果 [J]. 中國(guó)脊柱脊髓雜志, 2009, 19(2): 8589.
21. 徐懋, 張耕, 韋峰, 等. 球囊阻斷低位腹主動(dòng)脈在腰骶骨腫瘤手術(shù)中的應(yīng)用 [J]. 中國(guó)微創(chuàng)外科雜志, 2010, 10(2): 147149.
22. 米川, 馬忠泰, 盧海霖, 等. 球囊導(dǎo)管阻斷動(dòng)脈控制腫瘤術(shù)中出血的可行性研究 [J]. 中華骨科雜志, 2005, .25(5): 280283.
23. Tang X, Guo W, Yang R, et al. Risk factors for blood loss during sacral tumor resection [J]. Clin Orthop Relat Res, 2009, 467(6): 15991604.
24. 路小勇, 崔現(xiàn)平, 張志. 不同控制出血方法在骶骨腫瘤切除術(shù)中的應(yīng)用價(jià)值比較 [J]. 中國(guó)脊柱脊髓雜志, 2007, 17(12): 899903.
25. 馬澤民, 呂國(guó)華, 王冰, 等. 腹主動(dòng)脈阻斷與髂內(nèi)動(dòng)脈結(jié)扎控制出血在骶骨腫瘤切除手術(shù)中的應(yīng)用比較研究 [J]. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 2004, 14(2): 3335.
26. 張曉慶, 劉健慧, 郁慶. 骨盆和盆腔腫瘤無(wú)血手術(shù)技術(shù)的臨床應(yīng)用 [J]. 同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2008, 29(2): 5356.
27. 江晨, 邵性興, 劉希洪. 腹主動(dòng)脈阻斷法在盆腔手術(shù)中應(yīng)用3例體會(huì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 1998, 5(6): 382.
  1. 1. Masterson EL, Davis AM, Wunder JS, et al. Hindquarter amputation for pelvic tumors. The importance of patient selection [J]. Clin Orthop Relat Res, 1998, (350): 187194.
  2. 2. Turcotte RE, Sim FH, Unni KK. Giant cell tumor of the sacrum [J]. Clin Orthop Relat Res, 1993, (291): 215221.
  3. 3. 李鼎鋒, 崔秋, 樂(lè)守玉, 等. 腹主動(dòng)脈血流阻斷技術(shù)在行骨盆、骶骨腫瘤切除中的臨床評(píng)價(jià) [J]. 中國(guó)癌癥雜志, 2003, 13(3): 259262.
  4. 4. Simpson AH, Porter A, Davis A, et al. Cephalad sacral resection with a combined extended ilioinguinal and posterior approach [J]. J Bone Joint Surg Am, 1995, 77(3): 405411.
  5. 5. 北京大學(xué)人民醫(yī)院骨與軟組織腫瘤治療中心. 骶骨腫瘤的手術(shù)治療 [C]. 北京: 北京國(guó)際骨與軟組織腫瘤研討會(huì), 2003: 28.
  6. 6. Ozaki T, Liljenqvist U, Halm H, et al. Giant cell tumor of the spine [J]. Clin Orthop Relat Res, 2002, (401): 194201.
  7. 7. Salai M, Garniek A, Rubinstein Z, et al. Preoperative angiography and embolization of large pelvic tumors [J]. J Surg Oncol, 1999, 70(1): 4144.
  8. 8. Wirbel RJ, Roth R, Schulte M, et al. Preoperative embolization in spinal and pelvic metastases [J]. J Orthop Sci, 2005, 10(3): 253257.
  9. 9. Chatziioannou AN, Johnson ME, Pneumaticos SG, et al. Preoperative embolization of bone metastases from renal cell carcinoma [J]. Eur Radiol, 2000, 10(4): 593596.
  10. 10. 梁斌, 韋敏克, 李宏宇, 等. 動(dòng)脈栓塞對(duì)骨盆腫瘤手術(shù)療效的影響 [J]. 中國(guó)矯形外科雜志, 2006, 14(11): 831833.
  11. 11. Wuisman P, Lieshout O, Sugihara S, et al. Total sacrectomy and reconstruction: oncologic and functional outcome [J]. Clin Orthop Relat Res, 2000, (381): 192203.
  12. 12. Lackman RD, Khoury LD, Esmail A, et al. The treatment of sacral giantcell tumours by serial arterial embolisation [J]. J Bone Joint Surg Br, 2002, 84(6): 873877.
  13. 13. Lin PP, Guzel VB, Moura MF, et al. Longterm followup of patients with giant cell tumor of the sacrum treated with selective arterial embolization [J]. Cancer, 2002, 95(6): 13171325.
  14. 14. O’Donnell ME, Badger SA, Makar RR, et al. Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms [J]. J Vasc Surg, 2006, 44(1): 211215.
  15. 15. Mi C, Lu H, Liu H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases [J]. Spine (Phila Pa 1976), 2005, 30(20): E614E616.
  16. 16. Rutherford R. Vascular surgery [M]. Philadelphia: Saunders, 2000: 959970.
  17. 17. Ullmark G, Hovelius L, Strindberg L, et al. Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery [J]. Acta Orthop Scand, 2000, 71(1): 5154.
  18. 18. 潘水章, 何登偉. 低位腹主動(dòng)脈間歇性阻斷技術(shù)的臨床應(yīng)用 [J]. 臨床骨科雜志, 2000, 3(3): 183184.
  19. 19. Silberzweig JE, Marin ML, Hollier LH, et al. Balloonexpandable common iliac artery occluder device for endovascular aneurysm repair [J]. Vasc Surg, 2001, 35(4): 263271.
  20. 20. 唐順, 董森, 郭衛(wèi), 等. 腹主動(dòng)脈球囊阻斷控制骶骨腫瘤切除術(shù)中出血的效果 [J]. 中國(guó)脊柱脊髓雜志, 2009, 19(2): 8589.
  21. 21. 徐懋, 張耕, 韋峰, 等. 球囊阻斷低位腹主動(dòng)脈在腰骶骨腫瘤手術(shù)中的應(yīng)用 [J]. 中國(guó)微創(chuàng)外科雜志, 2010, 10(2): 147149.
  22. 22. 米川, 馬忠泰, 盧海霖, 等. 球囊導(dǎo)管阻斷動(dòng)脈控制腫瘤術(shù)中出血的可行性研究 [J]. 中華骨科雜志, 2005, .25(5): 280283.
  23. 23. Tang X, Guo W, Yang R, et al. Risk factors for blood loss during sacral tumor resection [J]. Clin Orthop Relat Res, 2009, 467(6): 15991604.
  24. 24. 路小勇, 崔現(xiàn)平, 張志. 不同控制出血方法在骶骨腫瘤切除術(shù)中的應(yīng)用價(jià)值比較 [J]. 中國(guó)脊柱脊髓雜志, 2007, 17(12): 899903.
  25. 25. 馬澤民, 呂國(guó)華, 王冰, 等. 腹主動(dòng)脈阻斷與髂內(nèi)動(dòng)脈結(jié)扎控制出血在骶骨腫瘤切除手術(shù)中的應(yīng)用比較研究 [J]. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 2004, 14(2): 3335.
  26. 26. 張曉慶, 劉健慧, 郁慶. 骨盆和盆腔腫瘤無(wú)血手術(shù)技術(shù)的臨床應(yīng)用 [J]. 同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2008, 29(2): 5356.
  27. 27. 江晨, 邵性興, 劉希洪. 腹主動(dòng)脈阻斷法在盆腔手術(shù)中應(yīng)用3例體會(huì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 1998, 5(6): 382.