鼻咽血管纤维瘤术前双重介入栓塞的临床价值

目的探讨双重介入栓塞对治疗鼻咽血管纤维瘤的临床价值。方法7例鼻咽血管纤维瘤患者,术前均行DSA造影检查,其中6例病灶主要由上颌动脉及颈内动脉分支供血,均行双重介入栓塞治疗即局部穿刺瘤体内直接栓塞 供瘤动脉栓塞;另1例仅上颌动脉供血,故仅行供瘤动脉栓塞。结果所有病灶在栓塞后造影检查中均明显缩小。结论双重介入栓塞治疗可作为鼻咽血管纤维瘤术前必备的辅助治疗措施。     

鼻咽部血管纤维瘤术前动脉栓塞的临床应用价值

目的 评价超选择性颈外动脉栓塞术在鼻咽部血管纤维瘤经鼻内镜切除术前的临床应用价值.方法 对20例鼻咽部血管纤维瘤患者经鼻内镜切除术前1 ～ 3 d行超选择性颈外动脉分支,供血动脉栓塞术,回顾性分析术中出血、手术时间及并发症等情况.结果 20例患者均成功接受超选择性颈外动脉栓塞术,1 ～ 3 d后行经鼻内镜切除术,平均术中出血155 ml,平均手术时间为75 min,栓塞术后6例发生轻度并发症,经对症治疗后消失.切除术后无严重并发症发生,术后平均住院时间为3.5 d.结论 超选择性颈外动脉栓塞术可明显减少鼻咽部血管纤维瘤术中出血和术后并发症,有效缩短手术时间,联合经鼻内镜切除术是鼻咽部血管纤维瘤微创、有效的治疗手段.     

经导管动脉栓塞术在鼻咽血管纤维瘤摘除术前的临床应用

目的：探讨经导管动脉栓塞术在鼻咽血管纤维瘤除术前的临床应用价值。方法：12例鼻咽血管纤维瘤,经股动脉行超选择插管造影,采用聚乙烯醇颗粒和／或明胶海绵颗粒栓塞肿瘤供血动脉,全部患于栓塞后3～7d手术切除肿瘤。结果：12例均见到明显的肿瘤染色,供血动脉丰富。颌上动脉栓塞12例,同时栓塞咽升动脉8例。所有病例均取得良好效果。结论：本组资料表明超选择插管造影诊断、栓塞、治疗及栓塞颗粒大小是技术成功的主要条件。经导管动脉栓塞术在鼻咽血管纤维瘤除术前的应用是安全有效的。     

超选择性栓塞在鼻咽纤维血管瘤术前治疗中的临床价值

目的探讨鼻咽纤维血管瘤(JNA)术前栓塞的价值。资料与方法回顾性分析21例病理证实的JNA患者的诊治情况,其中6例术前行供血动脉栓塞术。结果JNA栓塞后再行切除者,平均出血量、输血量均少于未行栓塞者,其中对于Ⅰ~Ⅲ期者先栓塞后行内镜切除者出血、输血量及手术时间明显减少。结论JNA术前栓塞疗效确切,对于Ⅰ~Ⅲ期者行栓塞术后再行内镜直视下切除效果好。     

鼻咽部纤维血管瘤的血管造影表现及手术前栓塞

目的：了解鼻咽部纤维血管瘤的血供情况及术前栓塞对术中出血、手术全切率和术后疗效的影响。材料与方法：对１６ 例鼻咽部纤维血管瘤患者进行数字减影血管造影,并经５Ｆ 造影导管用直径２５０ ～１０００μｍＩｖａｌｏｎ 栓塞肿瘤供血动脉。结果：鼻咽部纤维血管瘤主要由同侧的颌内动脉供血,同侧颈内动脉参与供血的占６／１６ ,对侧颈外动脉参与供血的占５／１６ 。供血动脉栓塞后肿瘤染色大部分消失,术中出血明显减少。结论：鼻咽纤维血管瘤的术前栓塞有助于减少术中出血,增加手术安全性,提高手术全切率和术后疗效。     

青少年鼻咽纤维血管瘤的辅助性介入栓塞

目的 介绍青少年鼻咽纤维血管瘤辅助性介入栓塞，特别是双重介入栓塞的经验。方法 14例青少年鼻咽纤维血管瘤患者，均为男性，年龄11～17岁。按照Fish分类，Ⅰ型1例、Ⅱ型1例、Ⅲ型8例、Ⅳ型4例。对于Ⅰ型和Ⅱ型仅由上颌动脉供血且病变只位于鼻腔内的2例患者，单纯行上颌动脉超选择的聚乙烯醇微球（PVA）栓塞；对于12例Ⅲ、Ⅳ型患者，血供来自上颌动脉和颈内动脉，病变除波及鼻腔外，还侵及颞下窝和颅底骨，行肿瘤直接穿刺α-氰基丙烯酸正丁酯（NBCA）栓塞，然后配以上颌动脉PVA栓塞的双重栓塞治疗。手术前后均行CT和MRI检查，术中行纤维血管瘤血管造影。结果 青少年鼻咽纤维血管瘤血管造影时表现为鼻咽部的异常血管团，颈外动脉的上颌动脉为主要供血动脉。14例患者均在辅助性介入栓塞后行手术摘除肿瘤。10例肿瘤分2次摘除，2例3次摘除，2例1次摘除。患者术中出血明显减少，1例输血800ml，4例输血400ml，9例未输血。结论 青少年鼻咽纤维血管瘤的辅助性介入栓塞可减少术中出血，提高肿瘤的切除率。介入栓塞应根据血供和病变位置的不同，选择不同的方法。     

脑膜瘤的DSA及术前栓塞治疗

目的探讨脑膜瘤血管造影表现及手术前栓塞治疗的应用。方法36例经病理确诊的脑膜瘤,术前全部行全脑血管DSA造影,将其中主要由颈外动脉供血的22例患者用PVA栓塞,栓塞治疗后3～10d行手术切除。结果36例患者中,单纯由颈外动脉供血的9例,颈外动脉和颈内动脉供血的25例,颈内动脉供血2例。22例行肿瘤供血动脉栓塞的患者中,栓塞后肿瘤血管染色完全消失16例,染色明显减轻6例。栓塞后行手术切除的22例脑膜瘤患者,病灶被全部切除,术中平均出血150～500ml。结论脑膜瘤可由颈内、颈外动脉单独或混合供血,脑膜瘤的术前颈外动脉栓塞有利于减少术中出血及肿瘤的完整切除。     

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。     

局部穿刺栓塞进展期青少年鼻咽纤维血管瘤

目的 探讨局部直接穿刺栓塞在青少年鼻咽纤维血管瘤(JNA)术前辅助性栓塞治疗中的临床应用价值.方法 29例JNA患者均行颈动脉造影明确肿瘤供血动脉.然后经皮直接穿刺到肿瘤内,注射组织胶栓塞瘤腔.结果 29例患者造影显示由颈内、颈外动脉双重供血.经局部直接穿刺栓塞后造影显示肿瘤血管染色明显减少,供血动脉远端未见明显显示.所有患者在栓塞后1周内行手术切除,术中出血明显减少,出血量150～500 ml,平均350ml.结论 直接穿刺肿瘤栓塞(DPTE)技术安全,能有效栓塞瘤腔,明显减少术中出血.     

鼻咽部血管纤维瘤动脉造影及治疗性栓塞临床价值(附12例分析)

目的：探讨鼻咽部血管纤维瘤的动脉造影特征及其术前栓塞的临床价值。方法：对１２例经手术和病理证实的鼻咽纤维血管瘤,按Ｓｅｌｄｉｎｇｅｒ′ｓ技术进行了超选择性动脉造影并栓塞治疗。结果：１２例均显示病变的范围、血供情况以及营养血管的特征。栓塞后术中出血减少到４００ｍｌ以下,并且获得了满意的临床效果。结论：选择性动脉造影能在切除肿瘤前进一步证实诊断并且显示肿瘤的范围,术前栓塞能大大减少术中出血,操作简便、安全     

Juvenile nasopharyngeal angiofibroma: Comparison of blood loss during removal in embolized group versus nonembolized group

Purpose This retrospective study was performed to assess the beneficial effect of preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) in terms of blood loss during surgery.Methods Intraoperative blood loss in a group of 7 patients who underwent 10 procedures for JNA without preoperative embolization was compared with the blood loss of 13 patients who underwent 16 procedures after embolization of one or both external carotid arteries.Results Mean blood loss was 5380 ml in patients with-out embolization and 1037.5 ml in those with embolization. This difference was not statistically significant because of the high standard deviation in the nonembolized group. However, when data were analyzed by tumor stage, a significant difference was noted between the embolized and the nonembolized patients with high-grade tumors but not between those with low-grade tumors.Conclusion Preoperative embolization of the branches of the external carotid appears to facilitate removal of high grade tumors. The benefit of embolization in those with low-grade tumors is less clear cut, probably because there is less vascularity in low-grade tumors and so removal is easier.     

Radiographic management of juvenile angiofibromas

Juvenile angiofibromas are benign, vascular, locally aggressive neoplasms that are preferably treated by surgical resection, or irradiation if surgery is not possible. Adequate surgery in the past has been limited by incomplete knowledge of the anatomy of the tumor and technical difficulties related to the vascularity. To better define the tumor, 12 patients with juvenile angiofibroma have been studied by axial and coronal high resolution computed tomography (CT). The extent of the neoplasm was better demonstrated by CT than by other techniques. Based on the CT findings, we propose an anatomic classification that is helpful in determining treatment methods. Nine patients were considered operable, and eight of these underwent preoperative embolization with Silastic spheres and Gelfoam. The preoperative embolization significantly reduced operative difficulty and the necessity for blood transfusions. Based on these cases, we believe the current radiographic management of juvenile angiofibromas should consist of plain films, CT, angiography and, in surgical cases, preoperative embolization.     

术前肿瘤动脉栓塞联合术中腹主动脉球囊阻断在骶骨肿瘤切除术中的应用

目的 探讨术前肿瘤动脉栓塞联合术中腹主动脉球囊阻断在骶骨肿瘤切除术中的应用价值.方法 本研究纳入56例患者.对照组(24例)行常规外科切除骶骨肿瘤;试验组(32例)行术前骶骨肿瘤动脉栓塞联合术中腹主动脉球囊阻断.计算两组的手术时间、术中出血量、术后1年肿瘤复发率,并进行统计学分析.结果 试验组患者造影显示骶骨肿瘤由多支血管供血,分别给予栓塞后在球囊阻断腹主动脉的辅助下成功切除肿瘤.试验组术中手术视野清晰,骶骨肿瘤切除时出血明显减少,术后未出现异位栓塞、肾缺血和肢体缺血等并发症.两组手术时间、术中出血量、术后1年肿瘤复发率差异均有统计学意义(P ＜ 0.05).结论 术前肿瘤动脉栓塞联合腹主动脉球囊阻断能有效缩短手术时间、减少术中出血,使肿瘤切除术中的手术视野更加清晰,明显提高了手术的安全性.     

巨型富血供脑膜瘤术前栓塞的临床应用

目的 探讨巨型富血供脑膜瘤术前栓塞的的临床应用价值.方法 选择2013年4月至2014年8月收治的71例巨大脑膜瘤(最大径＞5 cm)患者,术前MRI提示均强化明显,血供丰富,分成术前栓塞组(研究组)38例和未栓塞(对照组)33例,术前DSA造影确定血供分型为Ⅰ及Ⅱ型脑膜瘤,研究组予以PAV颗粒(200～300μm)栓塞,对照组仅行脑血管造影,未予以栓塞,观察两组术中出血、肿瘤切除时间及栓塞并发症情况;术后复查MRI观察切除程度.结果 研究组及对照组术中出血量(ml)(562±178)比(833±234)、肿瘤切除时间(h)(5.45±2.13)比(7.23±2.45)、肿瘤切除程度Simpson分级(Ⅲ及Ⅲ以下)27例(27/38,71％)比19例(19/33,57.6％),P＜0.05,差异均有统计学意义,7例出现栓塞后脑水肿加重,2例出现头皮缺血性坏死,1例出现术中癫痫发作,对症治疗后均缓解.结论 巨型富血供脑膜瘤术前栓塞可以明显减少术中出血、缩短手术时间,提高脑膜瘤的切除程度,值得在临床推广及应用.     

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.     

脊柱肿瘤术前栓塞疗效的影响因素分析

目的评价外科术前介入栓塞技术的安全性和对脊柱肿瘤切除术中出血量的影响。 方法回顾北京大学人民医院2003年3月至2011年5月90例行术前栓塞的脊柱肿瘤患者的临床资料,分析患者性别、病理类型、栓塞颗粒直径、栓塞与手术的时间间隔、是否为初次手术及肿瘤侵犯范围等因素对栓塞疗效的影响。 结果对于所有肿瘤和颈胸腰椎肿瘤,接受二次或多次手术的患者术中出血量大于首次接受栓塞及手术治疗的患者（P=0.023、0.044）;骨巨细胞瘤（GCT）患者术中出血量大于其他原发肿瘤（P=0.013、0.006）。患者性别、栓塞颗粒直径、栓塞与手术的时间间隔及肿瘤侵犯范围等因素对栓塞后肿瘤切除术中出血量无影响。 结论术前栓塞对减少脊柱富血供肿瘤的术中出血量、提高肿瘤的可切除性是安全、有效的。     

Endovascular Embolization of Spontaneous Retroperitoneal Hemorrhage Secondary to Anticoagulant Treatment

The purpose of this study was to report a single hospitals experience of endovascular treatment of patients with retroperitoneal hemorrhage (RPH) secondary to anticoagulant treatment. Ten consecutive patients treated in an intensive care unit and needing blood transfusions due to RPH secondary to anticoagulation were referred for digital subtraction angiography (DSA) to detect the bleeding site(s) and to evaluate the possibilities of treating them by transcatheter embolization. DSA revealed bleeding site(s) in all 10 patients: 1 lumbar artery in 4 patients, 1 branch of internal iliac artery in 3 patients and multiple bleeding sites in 3 patients. Embolization could be performed in 9 of them. Coils, gelatin and/or polyvinyl alcohol were used as embolic agents. Bleeding stopped or markedly decreased after embolization in 8 of the 9 (89%) patients. Four patients were operated on prior to embolization, but surgery failed to control the bleeding in any of these cases. Abdominal compartment syndrome requiring surgical or radiological intervention after embolization developed in 5 patients. One patient died, and 2 had sequelae due to RPH. All 7 patients whose bleeding stopped after embolization had a good clinical outcome. Embolization seems to be an effective and safe method to control the bleeding in patients with RPH secondary to anticoagulant treatment when conservative treatment is insufficient.phone +315-8-3153622 Fax +315-8-3155420     

局部穿刺栓塞治疗头颈部高血流病变

目的 总结局部穿刺栓塞治疗头颈部高血流病变的经验。方法 11例头颈部高血流病变(8例颌骨中心性血管瘤，3例鼻咽纤维血管瘤)进行了局部穿刺栓塞治疗。数字减影颈动脉造影在Philips V3000下完成。颌骨中心性血管瘤采用的栓塞材料为附纤毛的螺形圈，鼻咽纤维血管瘤采用的栓塞材料为组织胶(N-butyl-2-cyanoacrylate，NBCA)。穿刺针为14G和长7号注射针。结果 颌骨中心性血管瘤急性出血的患者经局部穿刺栓塞圈栓塞，有效控制了出血。随访9～24个月后，未发现有口腔内渗血或出血，随访X线平片可见螺形圈周围成骨。3例鼻咽纤维血管瘤局部穿刺栓塞后行手术治疗，手术中未行输血，完整摘除肿瘤。结论 局部穿刺栓塞治疗头颈部高血流病变是1种有效、安全的治疗方法。     

Use of Intra-Arterial Chemotherapy and Embolization Before Limb Salvage Surgery for Osteosarcoma of the Lower Extremity

We report our experience with the use of intra-arterial chemotherapy and embolization before limb salvage surgery in patients with osteosarcoma of the lower extremity. We evaluated the effect of this procedure on the degree of tumor necrosis and on the amount of blood loss during surgery. We reviewed the medical records of all patients who received intra-arterial chemotherapy and embolization before undergoing limb salvage surgery for osteosarcoma of the lower extremity at our institution between January 2003 and April 2008. Patient demographic, tumor characteristics, treatment details, postembolization complications, and surgical and pathological findings were recorded for each patient. We evaluated the operative time, estimated blood loss (EBL), and volume of blood transfusion during surgery and in the postoperative period in all patients in the study group. The same parameters were recorded for 65 other patients with lower extremity osteosarcoma who underwent limb salvage operation at our institution without undergoing preoperative intervention. The study included 47 patients (25 males and 22 females). Angiography showed that the tumors were hypervascular. Intra-arterial chemotherapy and embolization were performed successfully, resulting in a substantial reduction or complete disappearance of tumor stain in all patients. No major complications were encountered. At the time of surgery, performed 3–7 days after embolization, a fibrous edematous band around the tumor was observed in 43 of the 47 patients, facilitating surgery. The goal of limb salvage was achieved successfully in all cases. Percentage tumor necrosis induced by treatment ranged from 70.2% to 94.2% (average, 82.9%). EBL during surgery, EBL from drains in the postoperative period, total EBL, and transfusion volumes were significantly lower in the 47 study patients compared to the 65 patients who underwent surgery without preoperative treatment with intra-arterial chemotherapy and embolization. The mean operative time was also significantly less in the intervention group compared to the nonintervention group (73.2 vs. 88.5 min; p < 0.05). In conclusion, intra-arterial chemotherapy and embolization performed 3 to 7 days before limb salvage surgery in patients with lower extremity osteosarcomas can cause substantial tumor necrosis, reduce the EBL and transfusion requirements during surgery, and induce formation of a false capsule around the tumor, thus facilitating surgical excision of the tumors.