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目的:探讨骶骨肿瘤手术中应用不同方法控制出血的效果及其实用价值。方法:将143例骶骨肿瘤患者根据术中控制出血方法的不同分为6组,术前介入靶血管栓塞(A组)12例,髂内动脉结扎(B组)71例,球囊导管腹主动脉阻断(C组)9例,单纯低位腹主动脉阻断(D组)5例,低位腹主动脉阻断加髂内动脉结扎(E组)25例,未行控制出血的对照组(N组)21例。记录各组术中出血量,观察各组术中骶神经损伤、术中和术后出现休克死亡及术后1年复发等并发症情况。结果:各组术中出血量分别为N组5400±1756ml、A组3200±1060ml、B组3600±1146ml、C组1600±570ml、D组1650±540ml、E组1500±471ml,N组术中出血量显著大于A组和B组(P<0.05);C、D和E组术中出血减少,与N、A、B组比较均有显著性差异(P<0.05);C、D组术中出血量无显著性差异(P>0.05);E组术中出血量最少,与C、D组比较均有显著性差异(P<0.05)。N、A组的并发症发生率分别为4/21、2/12,两者之间无明显差异(P>0.05);B组的并发症发生率为6/71,与N、A组比较均有显著性差异(P<0.05);C、D、E组均未出现休克死亡、骶神经损伤、1年内复发等并发症。结论:腹主动脉阻断可有效控制骶骨肿瘤切除术中出血,低位腹主动脉阻断并髂内动脉结扎术是一种更有效和安全的手段。
Objective: To investigate the effect and practical value of different methods of controlling hemorrhage in sacral tumor surgery. Methods: 143 patients with sacral tumor were divided into 6 groups according to the method of intraoperative controlled bleeding. Preoperative interventional target vessel embolism (group A) 12 cases, internal iliac artery ligation (group B) 71 cases, balloon catheter abdomen Arterial block (group C) in 9 cases, simple low abdominal aorta block (group D) in 5 cases, low abdominal aorta occlusion plus internal iliac artery ligation (group E) in 25 cases without bleeding control group N group) 21 cases. The blood loss in each group was recorded. The sacral nerve injury, intraoperative and postoperative shock death and recurrence after operation were observed. Results: The intraoperative blood loss were 5400 ± 1756ml in group N, 3200 ± 1060ml in group A, 3600 ± 1146ml in group B, 1600 ± 570ml in group C, 1650 ± 540ml in group D and 1500 ± 471ml in group E respectively (P <0.05); bleeding in C, D and E groups was significantly lower than that in N, A and B groups (P <0.05); C, D group (P> 0.05). The blood loss in group E was the least, which was significantly lower than that in group C and D (P <0.05). The incidence of complications in group A and N was 4/21 and 2/12, respectively, with no significant difference (P> 0.05). The complication rate in group B was 6/71, which was significantly lower than that in group N and A (P <0.05). No complications such as shock death, sacral nerve injury and recurrence within one year occurred in C, D and E groups. Conclusion: Abdominal aorta block can effectively control the bleeding in sacrectomy, lower abdominal aorta occlusion and internal iliac artery ligation is a more effective and safe means.