选择性动脉栓塞在胸、腰段脊柱肿瘤治疗中的应用

目的 探讨减少脊柱肿瘤切除术中出血及提高肿瘤切除彻底性的有效方法。方法 １９８４年６月～１９９７年４月对１５例胸,腰段原发脊柱肿瘤（巨细胞瘤５例,恶性神经鞘瘤２例,脊索瘤１例,纤维黄色瘤１例,恶性纤维组织细胞瘤１例,骨母细胞型骨肉瘤１例,Ｅｗｉｎｇ肉瘤１例,骨髓瘤１例,平滑肌肉瘤１例,非何杰金氏淋巴瘤１例）术前彩 选择性节段性动脉栓塞,术中行病灶切除及脊椎重 中８例采用一期椎体全切除,结果 栓塞满     

选择性动脉栓塞在脊柱肿瘤治疗中应用

目的　减少脊柱肿瘤手术切除时的出血及因出血而造成的手术难度。方法　术前行选择性动脉栓塞 7例 ,未行动脉栓塞 9例作对照组 ,比较两组术中出血情况。结果　栓塞组患者术中出血明显少于对照组 ,平均出血量 (ml)栓塞组为 170 0± 10 0 ,对照组为 5 5 40± 381,P <0 0 1。结论　脊柱肿瘤切除前行选择性动脉栓塞 ,可减少术中出血量 ,有利于肿瘤与周围组织分离 ,肿瘤易完全切除     

靶动脉栓塞后骶骨肿瘤切除术的手术配合

骶骨肿瘤因解剖复杂、瘤体巨大、周围静脉丛丰富致术中出血量较大 [1] ,成为骨科手术中的难题。随着外科技术的发展 ,采取经腹暂时性阻断腹主动脉或髂内动脉结扎术、低温麻醉和控制性降压以减少术中出血 ,虽取得了一定效果 ,但失血量仍在2 0 0 0～ 2 0 0 0 0 ml[2 ] 。我院 1 996年 2月至 2 0 0 0年 2月 ,对 9例骶骨肿瘤病人术前栓塞靶动脉——髂内动脉[3 ] ,2 4 h内行骶骨肿瘤切除术 ,有效地减少术中出血量 ,降低手术危险性 ,从而为根治手术创造了条件。手术配合如下。1　临床资料9例中男 4例、女 5例 ,年龄 1 6～ 6 4岁 ,平均3 8.0岁。病…     

颈胸段脊柱肿瘤的外科治疗进展

颈胸段脊柱通常是指C7～T1椎节 ,该段肿瘤临床比较少见 ,由于该节段处于颈椎前曲与胸椎后凸交界处 ,其邻近解剖结构复杂 ,手术暴露困难 ,技术要求高 ,外科处理较为棘手。近年来随着内固定技术的提高以及脊柱肿瘤治疗理念的不断完善 ,颈胸段脊柱肿瘤的外科治疗也有了较大的发展。本文对颈胸段肿瘤的切除范围、应用解剖、手术入路及内固定作一综述。1　切除范围由于解剖关系复杂 ,Enneking外科分期用于颈胸段脊柱肿瘤的外科治疗不易把握。理论上 ,整块切除原发肿瘤病灶及其发生的间室最为理想 ,但因椎管内的脊髓不能切除 ,不易达到真正意义…     

脊柱肿瘤的手术治疗

目的 探讨脊柱肿瘤的早期诊断及外科治疗特点。方法 回顾性分析1994年6月至2000年8月共31例脊柱肿瘤的临床资料。所有患均施行手术治疗。包括肿块全部或部分切除及脊柱重建术。结果 平均随访30个月,手术优良率90.3%,21例神经功能恢复按Frankel分级提高1-3级。1例为颈部脊膜瘤术后8年复发。再次行手术治疗,术后症状缓解;6例转移癌术后5个月至4年内死亡。结论 脊柱肿瘤患应尽早争取手术治疗;对转移癌患,结合外科手术及系统的综合治疗能减轻症状,延长生存时间。     

脊柱肿瘤的手术治疗

目的 :探讨对于脊柱肿瘤一期全脊椎切除及脊柱稳定性重建的手术方法和临床效果。方法 :对 12例脊柱肿瘤行前、后路或前、后联合入路Ⅰ期全脊椎切除、脊髓减压 ,椎间植骨融合、内固定术。结果 :术后 11例获得随访 ,按照Frankel分级较术前均有 1级以上提高 ,所有患者局部疼痛症状消失。术后复查平均植骨融合时间 3个月。1例脊索瘤术后 1年复发 ,1例巨细胞瘤术后 9个月复发。结论 :针对脊柱肿瘤的性质、部位 ,通过不同的手术入路行一期全脊椎切除、植骨融合内固定 ,彻底切除肿瘤 ,重建脊柱稳定性并体现了个体化的治疗方向     

血管栓塞后肿瘤切除内固定治疗脊柱转移瘤

血管栓塞后肿瘤切除内固定治疗脊柱转移瘤邢更彦，姚建祥，陈克林，匡正达，李禾，孙炜恶性肿瘤脊柱转移占转移瘤的２０％左右。病人一旦发生脊柱转移，多为肿瘤晚期。常伴有剧烈疼痛、截瘫或脊髓及神经根受压症状。近年来，虽更多作者主张积极治疗，但碍于脊柱转移瘤切除...     

脊柱肿瘤的外科治疗进展

《神经外科聚焦》(NeurosurgicalFocus)杂志近期刊出了一期脊柱肿瘤的外科治疗专刊,13位作者分别就脊柱原发性和继发性肿瘤的诊断、治疗以及各个部位肿瘤切除后脊柱的重建分别进行了详细的阐述。Klimo等通过对最近20年来大量文献的阅读和总结,详细介绍了当今对脊柱肿瘤的治疗现状,指出脊柱肿瘤的外科治疗必须建立在对脊柱解剖的熟悉、肿瘤性质的了解以及手术治疗结合其他治疗方法的基础之上,从而获得良好的治疗效果。Liu和Apfelbaum等通过阅读文献回顾了颈椎肿瘤切除后的各种脊柱稳定重建的手术方法,讨论了各种方法的优缺点,尤其对骨水泥…     

靶血管栓塞后手术治疗骶骨肿瘤

目的：研究和评估经导管动脉栓塞后手术治疗骶骨肿瘤的价值和作用。方法：对２１例骶骨肿瘤用明胶海绵进行选择性动脉栓塞，栓塞后平均１．８天手术。结果：肿瘤均被顺利切除；术中出血大大减少，平均出血量为８９０ｍｌ。１６例获平均１８个月随访，未见局部复发。结论：靶血管栓塞后手术治疗骶骨肿瘤，可有效地减少术中出血，降低手术的危险性，增加肿瘤切除率和彻底切除的可能性，是十分有效的方法。     

117例脊柱肿瘤的手术治疗

由于脊柱局部解剖复杂,早期无典型症状,在诊断时往往已到晚期,手术治疗常存在较大的难度和危险。其外科治疗的关键和肢体肿瘤一样是彻底完整切除,以减少局部复发,提高生存率和治愈率。现将我院2004年3月至2007年3月治疗的117例脊柱肿瘤报告如下。     

选择性出血动脉栓塞在外伤性脾脏破裂出血处理中的应用

目的探讨选择性出血动脉栓塞在处理外伤性脾脏破裂出血中的效果。方法采用Seldinger技术穿刺右侧股动脉,把导管放至脾动脉后造影,显示脾脏出血部位,然后把微导管放至出血（叶、段）血管,注入PVA、明胶海绵颗粒等栓塞剂进行止血。结果44例脾动脉造影显示脾外伤（夏氏分级）Ⅱ级23例,Ⅲ级19例,Ⅳ级2例。44例均顺利完成选择性出血血管栓塞,其中脾叶动脉血管栓塞13例,脾段动脉血管栓塞31例;1次栓塞成功35例,再次栓塞成功9例。无继发出血及开腹手术病例,无死亡病例。术后1周血红蛋白、红细胞压积恢复正常。44例随访0.5～1年,无再出血、严重感染及其他并发症发生。结论选择性脾动脉出血血管栓塞是治疗外伤性脾破裂出血的一种有效、简便、微创的方法。     

Selective Arterial Embolization for the Treatment of Sacral and Pelvic Giant Cell Tumor: A Systematic Review

Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P‐values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow‐up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate.     

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。     

经导管髂内动脉栓塞在骨盆切除术中的意义

目的：研究和评估经导管髂内动脉栓塞后手术治疗骨盆肿瘤的价值和方法。方法：对30例骨盆肿瘤病人进行双侧髂内动脉栓塞,栓塞后1周内行手术治疗。结果：30例肿瘤均获彻底切除,术中出血大在和,平均出血为2200ml,平均随访28月,未见肿瘤局部复发。结论：术前经DSA栓塞双侧髂内动脉,可有效减少术中出血,利于种瘤切除,是骨盆肿瘤切除的十分有效的辅助治疗方法。     

铣刀椎板成形加椎管重建术在胸腰段椎管内肿瘤手术中的应用

目的探讨一种改良的保留棘突的全椎板成形、二孔钛板椎管重建方法在脊髓肿瘤手术中应用的可行性及有效性。方法回顾性分析2006年10月-2007年6月经全椎板成形、椎管重建的12例胸腰段脊髓肿瘤患者的临床资料。结果 12例患者均获肿瘤全切,术前症状均获不同程度改善。术后1周和术后6月分别行螺旋CT椎管三维重建,局部结构稳固,无一例发生固定件松动和回植椎板塌陷。结论保留棘突的全椎板成形、二孔钛板椎管重建,能满足手术的良好显露要求,又能很好的恢复椎管的解剖结构,提供稳定的后部支撑,减少粘连,并且不影响术后的影像学检查,方法简单易行,是一种有效的、切实可行的椎管重建方式。     

胸壁缺损修补重建方法探讨

胸壁肿瘤切除后，缺损的修补与重建是手术成败的关键。重建时使用的材料多样，方法各异。我们总结７５例胸壁肿瘤术后缺损修补的经验，比较自体组织与替代品修补重建的优缺点，认为使用自体组织作为缺损重建材料优点为取材容易方便，术后不易感染，值得推荐。     

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。     

Laser-Induced Thermotherapy Combined With Hepatic Arterial Embolization in the Treatment of Liver Tumors in a Rat Tumor Model

OBJECTIVE: To assess the effect of combined laser-induced thermotherapy (LITT) and hepatic arterial embolization with degradable starch microspheres (DSM) on tumor response and intrahepatic temperature distribution in rats with liver tumors. SUMMARY BACKGROUND DATA: Laser-induced thermotherapy is a promising in situ ablation technique for malignant liver tumors. However, clinical use is still limited, mainly because of the small size of the inducible coagulation necroses. This results in insufficient tumor destruction. METHODS: Colon carcinoma CC531 was implanted in 60 WAG rat livers. Fourteen days later, a silicon catheter was implanted in the hepatic artery for DSM administration. Tumors were exposed to 1064 nm Nd:YAG laser light at 2 watts for 10 minutes from a diffuser tip applicator placed in the tumor. The animals were randomized into a sham-operated control (group I) and three test groups. Group II received DSM alone, group III received LITT alone, and group IV received DSM + LITT. Tumor control was examined 1, 7, and 14 days after treatment. RESULTS: A complete tumor remission was achieved in all rats treated with LITT + DSM (group IV). In contrast, tumor progression was seen in animals treated with LITT alone (group III) or DSM alone (group II), as well as in the sham-operated controls (group I). CONCLUSIONS: The authors' results suggest that the combination of LITT and DSM considerably increases the efficacy of LITT in the treatment of liver metastases in the rat.     

A Randomised Controlled Trial of the Use of a Tourniquet to Reduce Blood Loss During Transtibial Amputation for Peripheral Arterial Disease

OBJECTIVES: To examine the effects of an exsanguination tourniquet on blood loss during transtibial amputation in patients with peripheral arterial disease (PAD). DESIGN: Prospective randomised blinded controlled trial. MATERIALS AND METHODS: Sixty-four patients undergoing transtibial amputation for non-reconstructible PAD were randomised to either tourniquet or no tourniquet (control). Blood loss (primary outcome), fall in haemoglobin, transfusion requirements, wound healing, breakdown and revision (secondary outcomes) were also recorded. RESULTS: Twenty-five patients in the tourniquet and 29 in the control group conformed to the trial protocol and completed the follow up. Intra-operative blood loss (median and IQR) was significantly greater in the control group compared to the tourniquet group (550 ml (255-1050) vs 255 ml (150-572.5), respectively, p=0.014, Mann-Whitney). There was a significantly greater drop in haemoglobin concentration (median and IQR) in the control compared to the tourniquet group (1.8 g/dl (0-1.2) vs 1.0 g/dl (0.6-2.4), p=0.035, t-test). Transfusion requirements were lower in the tourniquet group (p=0.05, Mann-Whitney). The rate of wound healing, breakdown and revision were similar in the tourniquet and control groups, respectively (59 vs 57%, 0 vs 9%, 14 vs 9%, p=NS). CONCLUSIONS: The use of a tourniquet during transtibial amputation for severe PAD reduces blood loss and need for blood transfusion.