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目的:探讨应用腹主动脉球囊阻断控制骶骨肿瘤切除术中出血的有效性和安全性。方法:2001年12月～2007年8月我院共完成骶骨肿瘤切除手术314例,其中179例在术中应用腹主动脉球囊阻断控制出血下完成骶骨肿瘤切除手术,男性97例,女性82例,年龄21～76岁,平均55岁。脊索瘤58例,骶骨转移癌42例,神经纤维瘤及神经鞘瘤25例,骨巨细胞瘤21例,骨髓瘤6例,尤文肉瘤3例,恶性神经鞘瘤3例,骨肉瘤2例,软骨肉瘤2例,畸胎瘤4例,动脉瘤样骨囊肿2例,其他良性肿瘤11例。其中肿瘤复发后再次手术患者61例,入院前曾接受过放疗21例。结果:术中出血量为450～8000ml,平均2650ml。19例(10.6%)患者因术后切口感染(5例)或切口皮肤缺血坏死愈合延迟(14例)进行二次手术清创缝合后愈合;2例(1.1%)术后出现动脉造影穿刺侧股动脉血栓,造成患侧下肢麻痹,行股动脉切开取栓术后症状缓解。137例原发骶骨肿瘤患者术后随访12～82个月,平均37个月。58例骶骨脊索瘤患者中,术中出血量≤3000ml者27例,局部复发10例(37.0%);术中出血量>3000ml者31例,局部复发18例(58.1%),术中出血量>3000ml者复发率明显高于术中出血量≤3000ml者(P<0.05)。结论:在行骶骨肿瘤切除手术时,术中应用腹主动脉球囊阻断可以有效控制术中出血,减少术后切口并发症的发生,降低肿瘤的局部复发率,从而提高骶骨肿瘤手术的有效性和安全性。
Objective: To investigate the effectiveness and safety of abdominal aorta balloon occlusion in the control of sacral tumor resection. Methods: From December 2001 to August 2007, 314 cases of sacral tumor resection were completed in our hospital. Of them, 179 cases underwent sacral tumor resection by abdominal aorta balloon occlusion during operation. There were 97 males 82 cases, aged 21 to 76 years, mean 55 years. 58 cases of chordoma, 42 cases of sacral metastases, 25 cases of neurofibromatosis and schwannoma, 21 cases of giant cell tumor of bone, 6 cases of myeloma, 3 cases of Ewing’s sarcoma, 3 cases of malignant schwannoma, 2 cases of osteosarcoma, 2 cases of chondrosarcoma, 4 cases of teratoma, 2 cases of aneurysmal bone cyst and 11 cases of other benign tumors. Among them, 61 patients underwent reoperation after tumor recurrence and 21 patients received radiotherapy before admission. Results: The intraoperative blood loss was 450 ~ 8000ml, with an average of 2650ml. 19 patients (10.6%) were healed by debridement and suturing after secondary incision infection due to incision infection (5 cases) or incision delayed necrosis of skin incision (14 cases); 2 cases (1.1%) had arteriography Lateral femoral artery thrombosis, resulting in ipsilateral lower limb paralysis, line femoral artery thrombectomy symptoms relieved. 137 patients with primary sacral tumors were followed up for 12 to 82 months, an average of 37 months. Of the 58 patients with sacral chordoma, 27 cases had intraoperative bleeding less than 3000 ml, 10 cases had local recurrence (37.0%), 31 cases had intraoperative blood loss more than 3000 ml, 18 cases (58.1%) had local recurrence, and the amount of intraoperative blood loss > 3000ml were significantly higher than the recurrence rate of intraoperative blood loss ≤ 3000ml were (P <0.05). CONCLUSIONS: Abdominal aortic balloon occlusion during operation of sacral tumor resection can effectively control the intraoperative bleeding, reduce the incidence of postoperative incision complications, and reduce the local recurrence rate of the tumor, so as to improve the effectiveness of sacral tumor surgery Sexuality and safety.