兩種阻斷方式對骶骨腫瘤切除術后傷口影響的比較

·臨床研究·

兩種阻斷方式對骶骨腫瘤切除術后傷口影響的比較

孔金海，肖輝，孫正望，許煒，劉鐵龍，宋滇文，嚴望軍，錢明，楊成，楊興海，吳志鵬，黃權，林在俊,鐘南哲,肖建如

作者單位：200003上海，第二軍醫大學附屬長征醫院骨腫瘤科

【摘要】目的探討選擇性靶血管栓塞與球囊阻斷2種方式對骶骨腫瘤術后患者傷口影響的比較。方法將104例骶骨腫瘤患者隨機分為2組，術前行選擇性靶血管栓塞(A組)53例，球囊導管腹主動脈阻斷(B組)51例，其中20例患者術前已經行放、化療。記錄各組患者術中出血量、手術時間、術后引流量，觀察2組患者術后傷口愈合情況。結果2組患者術中出血量、術后引流量相比差異無統計學意義(P>0.05)，2組患者手術時間、引流時間相比差異有統計學意義(P<0.05)。A組皮膚紅腫5例，愈合不佳8例，傷口竇道瘺口2例，皮膚壞死6例；皮膚大面積壞死2例；B組皮膚紅腫1例，愈合不佳1例，傷口竇道瘺口1例；2組間比較，B組切口愈合不佳及皮膚壞死發生率高于A組，差異有統計學意義(P<0.05)。隨訪2組患者術后0.5、1、2年腫瘤復發率差異無統計學意義(P>0.05)。A組術后1例死亡、1例發生骶神經損傷，3例出現大小便功能障礙；B組術后無死亡，1例發生一過性神經癥狀, 1例發生排尿功能障礙，術后1年左右恢復。結論球囊腹主動脈阻斷可有效地控制骶骨腫瘤切除術中出血，與選擇性靶血管栓塞相比對傷口影響更小。

【關鍵詞】骶骨; 脊椎腫瘤; 傷后愈合; 氣囊阻塞; 血管; 栓塞，治療性

作者簡介：孔金海(1978— )， 博士，醫師

【中圖分類號】R 739.42 【文獻標志碼】 A

DOI【】

收稿日期：(2013-12-20)

Comparation effect to incision of selective target artery embolization and abdominal aorta temporary balloon occlusion for blocking blood in sacrum tumor resectionKONGJin-hai,XIAOHui,SUNZheng-wang,XUwei,LIUTie-long,SONGDian-wen,YANWang-jun,QIANMing,YANGCheng,YANGXing-hai,WUZhi-peng,HUANGQuan,LINZai-jun,ZHONGNan-zhe,XIAOJian-ru.DepartmentofBoneTumor,ChangzhengHospital,SecondaryMilitaryMedicalUniversity，Shanghai200003，China

Abstract【】ObjectiveTo evaluate the effect to incision of the selective target artery embolization and the abdominal aorta temporary balloon occlusion for blocking blood in sacrum tumor resection. Methods A total of 104 cases with sacrum tumor were divided into 2 groups randomly, 53 cases were adopted with target artery embolization preoperation(Group A), while 51 cases used the temporary balloon occlusion of abdominal aorta to control the bleeding in operation(Group B). The blood volume, operation time, drainage were recorded. And 20 cases were performed with radiotherapy or chemotherapy before operation.The heal of the incision were observed. Results The blood volume and drainage of 2 groups had no statistical significance(P>0.05). The operation time and drainage time of 2 groups had statistical significance(P<0.05). Five cases with inflammation, 8 cases with undesirable healing, 2 cases with sinus or orificium fistulae,6 cases with cutaneous necrosis and 1 case with large acreage of the skin were in Group A. One case with inflammation, 1 case with undesirable healing, 1 case was with sinus or orificium fistulae and 1 case with cutaneous necrosis were in Group B. Conpared with Group A, Group B had higher incidence rate of undesirable healing and cutaneous necrosis, the difference had statistical significance (P<0.05).The difference of recurrence rate in 0.5,1,2 years of 2 groups had no statistical significance(P<0.05). One dead case, 1 case with sacral nerve injured, 3 cases with dysfunction of the bowels were in Group A. No dead case was in Group B, 1 case was suffered with temporary nerve syptoms, 1 case was suffered with dysfunction of the urination and recovered in 1 year. Conclusion The temporary balloon occlusion of abdominal aorta can control the bleeding of the operation sufficially in the resection of the sacrum tumor. And it has less complication of the incision necrosis than the selective target artery embolization.

【Key words】Sacrum; Spinal neoplasms; Wound healing; Balloon occlusion; Blood vessels; Embolization, therapeutic

J Spinal Surg, 2015,13(1):37-40

骶骨腫瘤因局部解剖較為復雜，后路骶骨腫瘤切除腰椎骨盆內固定重建手術存在出血量大、神經損傷、內臟損傷等諸多并發癥。術后切口相關并發癥也較多，主要為切口感染、愈合不良，皮膚壞死等[1]，但巨大骶骨腫瘤的完整切除還需要借助于術中的控制性降壓、選擇性靶血管栓塞或者腹主動脈球囊阻斷等方法以達到預期的效果[2-3]，為接下來的腫瘤綜合性治療提供有力的保障。介入……