骨盆恶性肿瘤的手术治疗

目的探讨骨盆恶性肿瘤手术治疗的方法.方法对16 例骨盆恶性肿瘤患者,根据术前CT或MRI表现,按Enneking分区及Enneki化疗3个疗程.先行双侧髂内动脉结扎,对能保ng骨肿瘤分期分类.对Enneking骨肿瘤分期Ⅱ期及转移瘤病人,术前留骨盆承重环的Ⅰ区、Ⅲ区、Ⅳ区肿瘤,直接手术扩大切除,不能保留骨盆承重环的Ⅰ区、Ⅲ区、Ⅳ区肿瘤,手术扩大切除肿瘤,自体或异体骨移植＋重建钢板固定.Ⅱ区肿瘤,手术扩大切除肿瘤,可调式人工半骨盆置换或瘤块切除,克式针固定骨水泥填塞.结果术后随访1～3.5 a,平均2.8 a.所有病人均能下地行走,无肢体短缩.结论根据骨盆肿瘤的部位选择相应的术式,可以最大限度地保留肢体功能.术前化疗和双侧髂内动脉结扎可提高骨盆肿瘤的切除率.     

术前动脉化疗栓塞在骨盆部肿瘤治疗中的价值

目的：探讨术前选择性动脉化疗栓塞在骨盆部肿瘤治疗中的价值。方法：对26例骨盆部肿瘤患者，术前先行选择性动脉化疗栓塞治疗，然后再实施手术。结果：血管造影清晰的显示了肿瘤的供血情况、病变大小、范围，栓塞后肿瘤血管消失。手术失血量明显减少，平均为(1364～146)ml，手术时间缩短，术后病理证实肿瘤均有不同程度的变性坏死。结论：骨盆部肿瘤术前动脉化疗栓塞可使手术出血减少，缩短手术时间，是术前最有效的辅助治疗手段。     

髂内动脉结扎栓塞化疗对直肠癌术后复发和转移的疗效观察

我们探讨双侧结扎、明胶海绵微粒栓塞及 5氟脲嘧啶(5 FU)注入髂内动脉化疗对预防直肠癌术后复发的疗效。资料与方法1.一般资料 :本组 12 8例 ,男 83例 ,女 4 5例 ,年龄 32～74岁 ,中位年龄 5 3 9岁。均经手术及病理证实诊断。按Dukes分期 ,B期 31例 ,C期 73例 ,D期 2 4例。腺癌 10 3例 ,粘液细胞癌 2 0例 ,未分化癌 5例。A组 72例 ,B组 5 6例。2 .方法 :对A组 72例于肿瘤切除前常规分离、结扎双侧髂内动脉 ,将 5 FU 10 0 0mg、丝裂霉素 10mg和凝胶海棉粉末的混合物注入结扎动脉的远端 ,其余手术步骤同B组。术后两组治疗相同。3.统计…     

髂内动脉栓塞化疗联合TURBT治疗膀胱癌疗效观察

应用髂内动脉栓塞化疗术联合经尿道膀胱肿瘤切除术（TURBT）治疗膀胱肿瘤9例。结果3年复发率为22．2％，与同期膀胱部分切除术（20％）相同，明显低于单纯膀胱肿瘤电切术（3．5％）。显示动脉栓塞化疗可使肿瘤血管萎缩，瘤体明显缩小，控制严重血尿，减少术中出血，防止肿瘤细胞播散转移，促使粘膜原位癌消失，增加了肿瘤电切的切除率。认为这种联合治疗方法可以取代膀胱部分切除术，对减少膀胱部分切除的次数，保留膀胱及其生理功能有一定意义。     

骨盆Ⅰ区肿瘤侵犯骶髂关节的手术治疗

本研究回顾了自2005年2月～2010年2月对骨盆Ⅰ区肿瘤[1]侵犯骶髂关节行手术切除12例的临床资料,并提出了应用脊柱钉棒系统重建脊柱及骨盆稳定性的初步经验. 1临床资料 1.1一般资料 本组12例,男7例,女5例;年龄23～61岁,平均42岁.软骨肉瘤3例,骨肉瘤2例,尤文肉瘤1例,恶性纤维组织细胞瘤1例,转移瘤2例,骨巨细胞瘤3例.术前所有患者行X线、CT及MRI检查,确定肿瘤及切除范围.     

肋间动脉栓塞胸椎肿瘤切除术的作用评价

目的：为了探讨肋间动脉栓塞联合胸椎肿瘤术对胸椎铁治疗效果。方法：应用肋间动脉栓塞后肿瘤切除术治疗１１例胸肿瘤病人。其中原发肿瘤４例,转换癌７例,９例行肿瘤全部切除,２例行肿瘤次全切除。结果：术后所有病人的脊髓神经功能均有不同程度改善,术中出血量明显较未肋间动脉栓塞者减少,文章对胸椎肿瘤的类型、外科治疗方法和肋间动脉栓塞术等问题进行了详细讨论。结论：肋间动脉栓塞联合胸椎肿瘤切除术对胸椎肿瘤具有较好的     

犬髂内动脉和阴部内动脉结扎对阴茎勃起功能的影响

２４条犬分别单侧或双侧结扎髂内动脉和阴部内动脉，并与对照组进行比较，测定阴茎海绵体内压、潜伏期和动脉血流速度。结果表明：单侧ⅡＡ或ＩＰＡ结扎损害阴茎勃起功能，但对侧动脉血流速度代偿性增加；双侧ⅡＡ或ＩＰＡ结扎阴茎不能勃起，但二个月后，勃起功能几乎都能恢复，动脉造影和组织检查提示恢复勃起功能取决于阴茎伴随动脉的代偿情况和平滑肌细胞缺血变性程度。     

急诊动脉栓塞术在产后出血中的应用

目的　评价急诊经导管动脉栓塞术 (TAE)治疗难治性产后出血的疗效及安全性。方法　 18例难治性产后出血选择性插管至双侧髂内动脉或子宫动脉 ,行数字减影血管造影 (DSA)明确出血原因、部位后 ,以直径 1～ 3mm明胶海绵颗粒栓塞。结果　插管成功率 10 0 % ,手术时间 3 0～ 60min ,平均 ( 4 5 .2± 4.8)min ,术后止血总有效率 10 0 %。术后随访 3～ 40个月 ,均无严重并发症发生 ,所有患者宫体按期复旧 ,转经后月经正常。结论　TAE创伤小 ,疗效快速肯定 ,术后短期及长期随访无严重并发症 ,对危及生命的产后出血是一种有效的治疗措施     

脊椎肿瘤的动脉栓塞和手术切除及内固定

脊椎肿瘤术前动脉栓塞及手术治疗,目前国内尚少见专题报告。我院骨科与放射科介入室自1991年5月～1992年7月行脊椎肿瘤术前动脉栓塞和肿瘤切除植骨与内固定术共6例,现报告如下。1资料与结果 本组6例,均为男性,年龄20～60岁,平均41.6岁。病因:原发脊椎巨细胞瘤2例,继发性脊椎肿瘤4例,其中2例分别为肝和甲状腺转移癌,其余2例未找到原发灶。肿瘤部位:T121例,L22例,L32例,L41例。均行双侧肋间动脉(或腰动脉)栓塞,手术切除肿瘤时间距动脉栓塞的时间除1例是72h外,5例为24～48h。手术出血量600～4000ml,平均出血量1600ml。6例都顺利地将肿瘤切除,…     

髂内动脉栓塞术治疗骨盆骨折合并失血性休克疗效分析

目的 探讨髂内动脉介入栓塞术（TAE）在骨盆骨折合并失血性休克救治中的应用效果。方法 回顾性研究2019年1月至2022年12月间本院收治的骨盆骨折合并失血性休克患者资料,按照纳入、排除标准选择入组共计74例,按治疗方式分为栓塞组和手术组各37例。记录两组病人治疗前后收缩压、心率、损伤严重程度评分（injury Severity score,ISS）及急诊室输血量,评价患者止血效果（满意：治疗后出血停止、血流动力学稳定;不满意：治疗后仍有出血、血流动力学不稳定）、术后24 h输血量、院内死亡率、术后并发症。结果 两组病人在平均年龄、受伤至入院时间、入院治疗前收缩压、心率、ISS评分方面差异无统计学意义,P>0.05。ISS评分均在16～25分,符合重伤诊断标准。两组病人手术后收缩压两组比较差异无统计学意义,治疗后栓塞组病人术后输血量较手术组明显减少、院内死亡率下降、止血效果好,P<0.05。栓塞组中有2例患者第1次栓塞后效果欠佳,进行第2次栓塞。术后发生下肢麻木和臀部皮肤红肿、栓塞后综合症（发热、恶心、呕吐、腹痛等）表现者共3例,经积极保守治疗后好转,无组织坏死等严重并发症...     

Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption

Introduction

Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a ‘tamponade effect’ of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation?

Materials and methods

We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90 mmHg after receiving 2 L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2 h), underwent therapeutic angiography within 24 h in order to control bleeding.

Results

Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%).

Conclusions

Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients.

     

3D-DSA在盆壁肿瘤术前介入栓塞中的价值

目的评价骨盆肿瘤术前单纯栓塞疗效和旋转DSA及三维重建对指导介入手术的价值。方法22例盆壁病变术前行单纯介入栓塞治疗,外科手术时机为介入手术后24小时内,栓塞材料为明胶海绵,计算术中估计失血量;其中11例进行旋转DSA及三维重建,与传统正位DSA指导下比较手术时间、透视时间及造影剂用量的差异。结果22例患者术中估计失血量为(1188.5±684.4)ml;旋转DSA及三维重建组病例与传统正位DSA组比较,手术时间和造影剂用量无差异(P>0.05),透视时间明显减少(P<0.05)。结论术前24小时内行明胶海绵颗粒单纯栓塞可明显减少盆壁病变术中出血,旋转DSA及三维重建技术对介入手术操作具有重要指导意义。     

小颗粒明胶海绵栓塞犬髂内动脉及骶正中动脉后并发症的研究

目的用小颗粒明胶海绵对犬髂内动脉及骶正中动脉行不同组合、不同级别栓塞,观察栓塞后并发症发生情况,为临床安全应用明胶海绵栓塞骶区血管提供参考依据。方法普通级成年健康犬16只,雄性14只,雌性2只,体重10～13 kg;随机分为5组。于数字减影血管造影监视下采用直径为50～150μm的明胶海绵颗粒,A组(3只)栓塞至双侧髂内动脉及骶正中动脉主干,B组(3只)栓塞至双侧髂内动脉及骶正中动脉一级分支,C组(3只)栓塞至双侧髂内动脉主干,D组(4只)栓塞至单侧髂内动脉及骶正中动脉主干,E组(3只)栓塞至单侧髂内动脉主干。栓塞前观察实验犬腹主动脉、双侧髂外动脉、髂内动脉及骶正中动脉的解剖关系。栓塞后观察实验犬存活情况,并于栓塞后3 d行犬直肠、膀胱、臀部肌肉及坐骨神经大体和组织学观察。结果犬的髂外动脉及髂内动脉无髂总动脉,双侧髂外动脉直接起始于腹主动脉,骶正中动脉起始有变异。血管栓塞后2 d内共7只实验犬死亡,其中A组3只,C组3只,D组1只;其余实验犬均存活至实验完成。A、C、D组死亡实验犬直肠发黑、坏死,膀胱呈片状发暗伴灶状充血水肿,膀胱内尿量中位数为270.6 mL。B、D、E组存活实验犬直肠无明显异常,膀胱仅轻度片状充血水肿,膀胱内尿量中位数分别为137.0、220.5、28.0 mL。A、C、D组死亡实验犬直肠、膀胱细胞崩解,伴大量炎性细胞浸润及上皮细胞脱落;B、D、E组存活实验犬栓塞后3 d膀胱、直肠轻度炎性细胞浸润,栓塞血管主要集中于直径为100～200μm的小动脉。各组坐骨神经与臀部肌肉除有轻度水肿外未见明显异常。结论 采用直径为50～150μm的小颗粒明胶海绵栓塞犬髂内动脉及骶正中动脉时,应注意栓塞近端血管至主干时至少需保留单侧髂内动脉,双侧髂内动脉与骶正中动脉同时栓塞时被栓塞血管近端不能超过其一级分支,否则可造成盆腔脏器坏死、穿孔等严重并发症。     

Pelvic arterial embolization in the setting of acute hemorrhage as a result of the anterior Prolift® procedure

Acute hemorrhage following pelvic reconstructive surgery is a complication requiring immediate evaluation and treatment. Therapeutic options include fluid resuscitation, tamponade techniques, exploratory surgical intervention, and, more recently, pelvic vessel embolization. New approaches to pelvic organ prolapse have been evolving rapidly with little reported on safety and efficacy. We present a 77-year-old female who had a life-threatening acute pelvic hemorrhage from an anterior Prolift^® procedure successfully treated with pelvic artery embolization.     

Clinical characteristics of pelvic fracture patients with gluteal necrosis resulting from transcatheter arterial embolization

Background: Transcatheter arterial embolization (TAE) can cause gluteal skin and muscle necrosis. However, the ultimate and typical signs of gluteal necrosis resulting from TAE have not yet thoroughly been investigated. Methods: From January 1995 to December 2003, 165 pelvic fractures were managed with TAE to control retroperitoneal bleeding at our level 1 trauma center. From these, 12 patients suffered gluteal muscle and skin necrosis. We reviewed the medical records of these 12 patients for age, gender, fracture type, embolic sites, computed tomography (CT) findings, serum creatine kinase level, site of skin necrosis, time from injury to skin necrosis, treatment, and outcome. Results: All 12 patients underwent TAE of the bilateral internal iliac arteries with gelatin sponge slurries. One patient suffered from an infection of the gluteal muscle from an open fracture site. Five patients presented with signs of gluteal soft tissue injuries on admission. Of these, four had skin abrasions and three revealed fluid or air collection under the gluteal skin on CT. The remaining six patients showed no evidence of soft tissue injuries on admission, and the lesions appeared between 2 days and 7 days after their admission. In these six patients, low-density areas (LDAs) of gluteal muscle with a clear border on the CT were observed following the appearance of skin lesion. The skin necrosis was located in the center of either or both buttocks, and signs of ischemia were clearly demarcated from the adjacent normal tissue. Four of 12 patients died from sepsis, three of whom suffered from uncontrollable gluteal infections that had been pointed out as LDAs on the CT. Conclusions: In every patient with gluteal necrosis associated with pelvic fracture following TAE, initial traumatic contusion cannot be ruled out as contributing to the development of the necrosis. However, for patients who undergo TAE of the bilateral internal iliac artery and who show clear-border LDAs on CT, skin necrosis centered on the buttock, and the delayed appearance of a skin lesion, careful attention must be given in the event of an arterial obstruction due to TAE.     

术前超选择性动脉栓塞对直肠癌根治术后血运转移影响的临床研究

目的:探讨腹腔镜直肠癌根治术前行超选择动脉栓塞对直肠癌血运转移的影响。方法:将60例直肠癌患者随机分为4组,A组行常规开腹手术,B组于开腹手术前行超选择直肠上动脉栓塞,C组行常规腹腔镜手术,D组于腹腔镜手术前行超选择直肠上动脉栓塞。4组患者分别于术前1 d、术后1年内每3个月应用逆转录聚合酶链式反应技术检测患者外周血癌胚抗原(carcinoembryonic antigen,CEA)mRNA含量。结果:A、B两组患者术后CEA mRNA差异有统计学意义(P<0.05);C、D两组患者间差异亦有统计学意义(P<0.05);A、C两组及B、D两组患者之间差异亦有统计学意义(P<0.05)。结论:腹腔镜直肠癌根治术前行超选择直肠上动脉栓塞治疗可明显降低直肠癌转移率,提高直肠癌根治效果,可望延长患者的生存时间、减轻痛苦、提高生存质量。     

超选择性动脉栓塞术治疗骨盆骨折大出血的疗效评价

目的 :探讨超选择性动脉栓塞术治疗骨盆骨折并发大出血的可行性与临床疗效。方法 :收集2008年3月至2016年2月诊治的65例骨盆骨折大出血患者的临床资料,将入选病例按是否行血管栓塞治疗分为非栓塞组与栓塞组,其中非栓塞组33例,男26例,女7例;年龄21~64(39.2±5.7)岁;受伤至入院时间1.1~4.8(2.2±0.4)h;根据AO/Tile分型,B型骨折12例,C型骨折21例;ISS评分25~42(37.7±7.5);休克指数评分1.7~2.4(2.1±0.3)分;以大量输血、补液为主。栓塞组32例,男25例,女7例;年龄22~65(38.1±4.5)岁;受伤至入院时间1.2~4.8(2.1±0.5)h;B型骨折14例,C型骨折18例;ISS评分26~43(38.9±4.5)分;休克指数评分1.6~2.4(2.2±0.2);在上述基础上加行超选择性动脉栓塞术。记录并比较两组患者的输血量、输液量、休克纠正时间和存活率,并记录栓塞组患者止血有效率和术中术后并发症。结果:栓塞组造影发现损伤血管37支,患者在术后3 h内出血得到控制,血流动力学趋于稳定,栓塞组在输血量、输液量、休克纠正时间方面优于非栓塞组(P0.00);栓塞组的存活率显著优于非栓塞组,差异有统计学意义(χ~2=7.890,P=0.005);两组患者并发症比较差异有统计学意义(χ~2=4.03,P=0.045)。结论 :超选择性动脉栓塞术治疗骨盆骨折大出血,止血精准高效、减少输血、输液量和休克发生率,提高患者存活率,值得临床推广。     

不同控制出血方法在骶骨肿瘤切除术中的应用价值比较

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±1756 ml、A组3200±1060 ml、B组3600±1146 ml、C组1600±570 ml、D组1650±540 ml、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.