骶髂骨肿瘤切除术前介入栓塞价值

目的 评估骶、髂骨肿瘤术前经导管超选择性动脉栓塞的价值和作用.方法对15 例骶、髂骨肿瘤用明胶海绵颗粒行超选择性动脉栓塞,栓塞后1～3 d行手术切除.疾病包括:骨巨细胞瘤5 例、动脉瘤样骨囊肿2例、转移瘤2 例、软骨肉瘤4例、脊索瘤3例.结果本组15 例栓塞后造影均显示肿瘤染色范围均较术前减少80 %以上.术中失血500～2600 ml 之间,平均为1100 ml .所有肿瘤均被顺利切除.结论 骶、髂骨肿瘤手术治疗前超选择性动脉栓塞能安全有效地减少术中出血, 提高肿瘤手术治疗效果并降低手术的风险.     

骶骨肿瘤术前超选择性动脉栓塞的意义

目的：研究和评估骶骨肿瘤术前经导管超选择性动脉栓塞的价值和作用。方法：对１６例骶骨肿瘤用明胶海绵或白芨粉行超选择性动脉栓塞,栓塞后平均３．５天行手术切除。疾病包括：骨巨细胞瘤３例、脊索瘤８例、动脉瘤样骨囊肿２例、转移瘤３例。结果：本组１６例栓塞后造影的显示肿瘤染色均较术前减少８５％以上。术中失血５００～１５００ｍｌ之间,平均为７８０ｍｌ。所有肿瘤均被顺利切除。结论：超选择性动脉栓塞手术治疗骶骨肿瘤     

脊柱,骨盆肿瘤术前栓塞对减少术中失血的意义

目的：通过对脊柱、骨盆肿瘤的术前栓塞的分析，为外科手术提供一种减少术中失血的有效新方法。材料和方法：本组３０例接受术前栓塞治疗３１次。疾病包括：软骨肉瘤１０例，骨肉瘤６例，转移瘤６例，骨巨细胞瘤５例，脊索瘤２例和动脉瘤样骨囊肿１例。栓塞物质为明胶海绵、钢丝圈和聚乙烯醇。结果：本组３０例栓塞后造影显示肿瘤染色均较栓塞前减少７５％，术中失血在８００～２８００ｍｌ之间，平均１５００ｍｌ。结论：本研究表明，脊柱、骨盆肿瘤术前栓塞能够有效地减少术中失血，提高手术治疗成功率，是一种有价值的术前辅助性治疗方法。     

脊椎血管瘤的影像学诊断及介入治疗的临床应用价值

目的 探讨脊椎血管瘤的影像学特点及介入治疗的价值.方法 分析20例经手术病理证实的脊椎血管瘤的影像学征象,对其中16例行术前动脉造影并栓塞治疗.结果 脊椎血管瘤X线平片表现为椎体呈典型的栅栏样改变;CT片可见网眼状影像中夹杂着低密度脂肪影;MRI T1加权像上呈等或高低混杂信号,T2加权像上呈均匀高信号,并可见随回波时间延长信号逐渐变亮这一典型血管瘤信号特征.对16例23个椎体共栓塞血管36支.栓塞后造影显示染色均较栓塞前减少75%以上.结论 脊椎血管瘤具有影像学特征性表现.术前动脉栓塞可以有效减轻疼痛,减少术中出血,是有效的辅助性治疗手段.     

动脉瘤样骨囊肿的影像学特点及介入技术在其诊疗中的意义

目的探讨动脉瘤样骨囊肿(ABC)的影像学特点及介入法动脉栓塞对该病的临床应用价值。方法回顾性分析18例经手术病理证实的原发性ABC的影像学征象,其中10例曾于术前进行动脉栓塞治疗。结果ABC的X线平片常呈偏心性膨胀性骨破坏;在CT成像中,10例可见液平面,8例出现钙化或骨化;MRI成像表现为分隔状囊性病变区,在T1加权像为不均匀中高信号,在T2加权像数个呈高信号囊腔及低信号的间隔影,12例出现液平面。结论动脉瘤具有一定的影像学特点,介入法是一种有价值的术前辅助性治疗方法。     

骨肿瘤的术前栓塞初步研究：以术中失血较多的脊椎,骨盆肿瘤…

脊椎、骨盆肿瘤的术前栓塞为外科手术解决术中失血提供了一种有价值的新方法。本组９例共接受术前栓塞１０次。病种有：软骨肉瘤、骨肉瘤、转移瘤、骨巨细胞瘤等。栓塞物质为明胶海绵和钢丝圈。以术中失血量作为疗效评价指标。栓塞后造影显示肿瘤染色均较栓塞前减少７５％以上。９例术中失血量在８００￣２８００ｍｌ之间，平均术中失血１８００ｍｌ；未经栓塞治疗的病例术中失血多在３５００ｍｌ，多者可达１５０００ｍｌ，且手术成     

骨盆肿瘤术前经导管动脉栓塞治疗的价值

目的　评价骨盆肿瘤术前局部动脉内灌注化疗和栓塞治疗的价值。资料与方法　术前栓塞治疗 4 8例骨盆肿瘤患者 (栓塞组 ) ,观察其临床改善情况 ,计算术中失血量和手术时间 ,并与 16例术前未栓塞骨盆肿瘤患者(对照组 )进行对照。结果　血管造影可清楚显示肿瘤的大小及血供特点 ,栓塞组术中失血量 2 177.1± 96 9.8ml,手术时间 198.9± 97.4min ;对照组术中失血量 4 4 6 2 .5± 1876 .8ml,手术时间 2 86 .4± 14 4 .5min。栓塞组均明显低于对照组 (P <0 .0 1)。手术时机的选择影响栓塞治疗的效果。组织学证实 :肿瘤均有不同程度的坏死、液化和囊性变 ,部分肿瘤有假包膜形成。结论　术前栓塞是骨盆肿瘤手术前最有效的辅助治疗手段 ,并且使手术易于操作。手术时机应选择在栓塞后 6天以内     

动脉瘤样骨囊肿的影像学诊断价值

动脉瘤样骨囊肿(aneurysmal bone cyst,ABC)是一种少见的瘤样病变,术前误诊率较高.笔者收集经手术及病理证实的14例原发性ABC的临床及影像学资料,分析其影像学特征,以提高对本瘤的认识,进一步提高术前的诊断率.     

经皮穿刺动脉栓塞在骨与软组织肿瘤治疗中的价值

目的：评价选择性动脉栓塞术在骨与软组织肿瘤术前应用的价值。方法：对11例骨与软组织肿瘤（5例恶性,6例良性）先行数字减影血管造影,再用明胶海绵和/或钢丝圈栓塞全部供血动脉,栓塞术后24h内手术切除肿瘤。结果：11例患者均成功手术,术中平均失血量为900ml(500-1800ml)。结论：选择性动脉栓塞在骨与软组织肿瘤术前应用具有显著止血效果。     

动脉瘤样骨囊肿的影像和病理学表现

目的:分析动脉瘤样骨囊肿(aneuriysmal bone cyst,ABC)的影像学及病理学特点,以期提高ABC的诊断水平。方法:回顾性分析32例经病理证实的动脉瘤样骨囊肿的影像学表现,全部病例中行X线检查20例,行CT检查17例,行MRI检查14例,部分患者在X线检查后进行了CT或MRI检查。结果:病灶分布于四肢长骨18例,脊椎8例、骨盆4例、下颌骨1例、跟骨1例;在X线和CT表现为上ABC表现为偏心性和膨胀性骨质破坏,MRI表现为多囊性病灶,T1WI呈低信号,T2WI呈高信号;病理均表现为含血囊腔及结缔组织性的间隔。结论:动脉瘤样骨囊肿有其特征性影像学表现,普通X线检查是最基本的首选检查方法,CT和MRI在显示动脉瘤样骨囊肿病灶内部结构和鉴别诊断上具有优势,综合影像学检查能提高动脉瘤样骨囊肿诊断符合率。     

Aneurysmal bone cysts treated by superselective embolization

A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.     

脊柱肿瘤术前选择性动脉栓塞术的临床价值

目的探讨脊柱肿瘤术前选择性动脉栓塞术的临床应用价值。方法回顾性分析2017年1月至2018年12月于中国医科大学附属盛京医院骨科行脊柱肿瘤切除手术的42例患者的临床资料,依据肿瘤切除术前是否行动脉栓塞治疗,将患者分为栓塞组(20例)和未栓塞组(22例),再根据手术方式分为椎体切除亚组和椎板切除亚组。栓塞组椎体切除12例、椎板切除8例;未栓塞组椎体切除13例、椎板切除9例。采用独立样本t检验比较各组间术中失血量、红细胞输入量、校准失血量、手术时间和住院时间的差异。结果栓塞组20例患者均成功实施了脊柱肿瘤动脉栓塞术,无严重并发症发生。栓塞组与未栓塞组患者术中失血量、红细胞输入量、校准失血量、手术时间和住院时间,差异均无统计学意义(P>0.05)。栓塞组椎体切除患者,术中失血量、红细胞输入量和校准失血量分别为(1966.7±898.8)ml、(7.42±3.27)U和(91.3±39.2)g/L,未栓塞组椎体切除患者分别为(2838.5±1143.5)ml、(11.04±4.08)U和(133.0±46.4)g/L,差异均有统计学意义(t值分别为-2.107、-2.436、-2.419,P<0.05);而2组手术时间和住院时间差异均无统计学意义(t值分别为-0.780、-0.549,P>0.05)。栓塞组与未栓塞组椎板切除患者的上述各指标差异均无统计学意义(P>0.05)。结论脊柱肿瘤术前选择性动脉栓塞术相对安全。脊柱肿瘤术前动脉栓塞不能减少外科切除手术的失血量,但对外科术式加以区分后,术前栓塞可显著减少接受椎体切除手术患者的失血量,而椎板切除手术的患者无明显受益。     

Spinal metastases from renal cell carcinoma: effect of preoperative particle embolization on intraoperative blood loss

BACKGROUND AND PURPOSE: Surgical repair of spinal metastases from renal origin is often complicated by excessive bleeding. The purpose of this study was to assess the effect of preoperative particulate embolization on intraoperative blood loss. METHODS: Twenty spinal metastases from renal origin (17 patients) treated by preoperative embolization with polyvinyl alcohol particles were analyzed retrospectively. Surgical decompression was performed within 2 days after embolization. A control group of 10 patients with 11 spinal metastases of renal origin underwent surgery without embolization. The effect of preoperative embolization, of completeness of embolization, and of particle size on the estimated intraoperative blood loss was analyzed using nonparametric statistical tests. RESULTS: Complete embolization was achieved in 10 cases and partial embolization in the other 10. The estimated blood loss of 19 embolized and 11 control cases was available from the surgical report. Median intraoperative blood loss in 19 embolized lesions was 1500 mL (range, 300-8000 mL), compared with 5000 mL (range, 1440-15000 mL) in the control group. Even after partial embolization, blood loss (median, 2000 mL) was significantly lower than in the control group. No significant differences in estimated blood loss were noted between the use of particles smaller than 250 microm and those larger than 250 microm. No embolization-related permanent neurologic deficit or skin or muscle necrosis occurred. CONCLUSION: Preoperative embolization of spinal metastases of renal origin with polyvinyl alcohol particles is safe and might reduce intraoperative blood loss significantly. Even partial embolization seems to be effective.     

椎管内血管畸形的血管造影诊断与血管内介入治疗

目的:探讨椎管内血管畸形的血管造影诊断与血管内介入治疗效果。方法:回顾性分析66例椎管内血管畸形的选择性动脉造影与栓塞治疗资料。结果:66例椎管内血管畸形的血管造影表现为隐匿性髓内血管畸形者6例,余60例均能显示病变的范围、血供情况及其特征。12例髓内动静脉畸形、17例硬脊膜动静脉瘘和9例髓周动静脉瘘接受了栓塞治疗,其愈显率分别为58.3%、64.7%和66.7%。所有栓塞病例均无严重并发症发生。结论:经选择性血管造影确诊后行栓塞治疗是椎管内血管畸形安全有效的治疗手段。     

Preoperative Onyx embolization of aggressive vertebral hemangiomas

We report the first use of Onyx in the embolization of spinal tumors in 2 cases of aggressive vertebral hemangioma. In both cases, Onyx embolization provided effective preoperative tumor devascularization after the initial prolonged particulate embolization with Embospheres made little overall impact. Onyx enables a more rapid and visible embolization than particles and is less technically demanding than traditional liquid embolic agents, such as n-butyl cyanoacrylate.     

中枢神经系统血管母细胞瘤术前栓塞

目的 探讨术前栓塞对中枢神经系统血管母细胞瘤手术切除的作用。方法 11例经CT、MRI及DSA检查诊断为中枢神经系统血管母细胞瘤患者，8例病变位于小脑，1例位于延髓，2例位于脊髓胸段内。手术切除前均在局麻下经微导管行供血动脉PVA颗粒栓塞。栓塞后均行手术切除肿瘤。结果 微导管均到达供血动脉，注入适量直径为250～350μmPVA颗粒后，6例完全栓塞，肿瘤血管和肿瘤染色完全消失；5例大部栓塞，肿瘤血管和肿瘤染色仅存小部分。11例栓塞后均顺利实施肿瘤手术切除。与既往未栓塞的病例相比较，行术前栓塞的病例手术时肿瘤界限清楚，术中出血减少，手术视野清晰，不易误伤邻近正常结构，容易分块切除，手术时间缩短，6例完全栓塞者表现尤为显著。11例手术均未出现并发症。结论 术前栓塞对血管母细胞瘤手术切除可使肿瘤切除更为容易，临近正常结构不易损伤，手术时间缩短，术中出血明显减少，手术并发症及病死率降低。     

脊髓血管畸形的DSA检查与栓塞治疗

目的 探讨脊髓血管畸形的DSA检查与栓塞治疗。资料与方法 搜集脊髓血管畸形9例。临床均表现为进行性脊髓损害。经股动脉穿刺插管，对每一对肋间动脉和腰动脉进行造影，颈髓血管畸形者行双侧椎动脉，甲颈干及肋颈干造影，9例中，单纯栓塞6例。单纯手术2例。未治1例。结果 选择性脊髓血管DSA的病变显示率达100%。栓塞治疗的6例，临床症状均有明显改善。结论 选择性脊髓血管DSA是诊断脊髓血管畸形的可靠依据。栓塞治疗操作简便，创伤性小，并发症少，是非手术治疗脊髓血管畸形的优良方法。     

选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用

目的 探讨选择性鼻咽纤维血管瘤供血动脉术前栓塞的应用价值。方法 对15例鼻咽纤维血管瘤行数字减影血管造影(DsA)检查和栓塞治疗。供血动脉主要为颈外动脉的颌内动脉和(或)咽升动脉,栓塞材料用明胶海绵。结果15例在选择性颈外动脉栓塞后行手术治疗,13例术中出血量明显减少,2例由颈外动脉,颈内动脉系统同时供血,仅选择性颈外动脉栓塞,术中出血量较多。栓塞后2～5d手术最为理想。结论鼻咽纤维血管瘤供血动脉术前栓塞是临床有效的治疗方法之一。     

Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature

BACKGROUND AND PURPOSE: Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region. METHODS: Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one. RESULTS: Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years). CONCLUSION: Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.     

脊柱转移瘤MRI诊断(附45例报告)

目的　探讨MRI对脊柱转移瘤的敏感性 ,以提高脊柱转移瘤MRI表现的认识。方法　回顾性分析 45例脊柱转移瘤的MRI表现 ,结合文献进行讨论。结果　 45例中共累及 14 9节椎体 ,累及椎弓根 19例 3 2根 ,棘突及横突 7例 11处。椎体压缩呈盘状 8例 2 1节 ,呈楔状 7例 11节 ,病椎轻度膨胀 4例 ,有软组织肿块 18例 ,硬膜囊、脊髓受压 15例 ,脊髓受侵 2例。病椎信号均匀 2 8例 ,不均匀 17例。T1WI为明显低信号 15例 ,略低信号 2 7例 ,等信号 3例。T2 WI为明显高信号 17例 ,略高信号 2 5例 ,等信号 3例。增强 18例 ,病灶明显强化 11例 ,轻度强化 6例 ,不强化 1例。软组织肿块边缘水肿、受压和受侵脊髓在MRI上均显示阳性。结论　MRI检查脊柱转移瘤的敏感性明显优于CT和X线平片 ,尤其肿瘤浸润椎骨尚属水肿、出血、坏死阶段时。