球囊导管腹主动脉阻断术控制骨盆及下腰椎肿瘤手术出血

目的探讨球囊导管腹主动脉阻断术控制骨盆及下腰椎肿瘤手术出血的临床意义、应用经验与适应证选择。方法本组16例患者(骨盆肿瘤14例,下腰椎肿瘤2例)。使用AngiostartTOP1250mA血管机配置的径线测量软件计算阻断部位腹主动脉的直径,选取直径大于测量数值1～2mm的双腔球囊导管,将球囊置于肾动脉远端的腹主动脉段。切开皮肤前充盈球囊。每次充盈时间为45min,间歇10min,使手术操作在腹主动脉血流暂时阻断的情况下得以完成。结果16例中,手术时间为45～150min,平均90min;术中出血量400～2000ml,14例骨盆肿瘤平均出血800ml,2例下腰椎肿瘤出血分别为1500ml和2000ml。本组病例均未发生下肢静脉血栓形成、肢体远端缺血性坏死、肾功能衰竭等并发症。结论球囊导管腹主动脉阻断术阻断血流可靠,能大幅度减少手术出血,不增加新的切口和损伤,减少了选择性动脉栓塞的并发症,提高了手术安全性。

Control of haemorrhage during the tumor resection operation of the pelvis or lower lumbar vertebrae by temporary balloon occlusion of the abdominal aorta

Objective To discuss the clinical significance, application and the selection of indications of the temporary balloon occlusion of abdominal aorta in the operations of pelvic or lower lumbar vertebral tumors. Methods Temporary balloon occlusion of abdominal aorta was used in 16 patients during the operations(of which 14 were pelvic tumors and 2 cases were lower lumbar vertebral tumors). A latex occlusion balloon was placed in the abdominal aorta below the opening of renal artery just before the operation. The diameter of the balloon was 1-2 mm larger than the abdominal aorta according to the measurement of Angiostart TOP 1250 mA X-ray machine. At the beginning of the operation, the predetermined volume of saline was injected to inflate the balloon. The balloons were inflated every 45 minutes with 10 minutes of free interval and the operations were undertaken under temporary totally occlusion of the abdominal aorta. Results The mean time of operations was 90 minutes (45-150 minutes). The loss of blood ranged from 400 ml to 2 000 ml, with an average of 800 ml in the 14 cases of pelvic tumors and 1 500 ml,2 000 ml of the two lower lumbar vertebral tumors, respectively. No lower limb venous thrombus or ischemic necrosis or failure of renal function happened. Conclusion The effect of temporary balloon occlusion of abdominal aorta was reliable. It sharply reduced the loss of blood with less complications of selective arterial embolism and made the operation of pelvic or lower lumbar vertebral tumors much more safer.