暂时低位腹主动脉阻断用于骨盆、骶骨肿瘤切除术的安全性探讨

目的 探讨暂时低位腹主动脉阻断技术用丁骨盆、骶骨肿瘤切除术的安全性.方法 选择27具尸体标本,测量第三、四腰横动脉的距离,第四腰横动脉全骶正中动脉的距离.选择暂时低位腹主动脉阻断行骨盆、骶骨肿瘤切除术患者14例,男9例,女5例;年龄20～56岁,平均39.6岁;骨盆肿瘤5例,骶尾部肿瘤7例,股骨近端骨肉瘤行半骨盆离断2例.测定手术前、后小同时间点静脉血浆总超氧化物歧化酶(T-SOD)活力及血浆丙二醛(MDA)含量.记录阻断时间、手术出血量、术后神经、血管症状及体征.结果 第三、四腰横动脉的半均距离为(2.18±0.48)cm,第四腰横动脉到骶正中动脉的距离为(1.09±0.62)cm.患者单次阻断时间最短52 min,最长84 min,平均(68.16±16.23)min.患者术中总出血最为1000～4000ml,平均2600ml.再灌注后0.5 h和2 h与缺血期比较,血中T-SOD活力均有不同程度降低,再灌注后2 h降低最明显.解除阻断后双下肢皮温偏低、皮肤苍白,约6～8 h后缓解,下肢轻度肿胀,感觉、运动正常.结论 第三、四腰横动脉间隙为最佳阻断部位.低位腹主动脉阻断可明显减少骨盆、骶骨手术中出血量,阻断后形成的缺血一再灌注损伤轻微.

Anatomy and security study of temporary block of lower abdominal aorta in the surgical treatment of patients with sacral or pelvic tumor

Objective To evaluate security of temporary block of lower abdominal aorta in the snrgical treatment of the patients with sacral or pelvic tumor.Methods 27 specimens were dissected.The distance between the thiM and fourth transverse lumbar artery and the distance between the fourth transverse lumbar artery and median saeral artery were measured.Temporary block of lower abdominal aorta were used in 14 patients with sacral or pelvic tumor during operation,the changes of total superoxide dismutase (TSOD)and malondialdehyde(MDA)in the venous blood were studied during the difierent perioperative periods.The volume of bleeding during operation was measured.Postoperative symptom of nerves and blood vessel were observed.Results The average distance between the third and fourth transverse lumbar artery was(2.18±0.48)cm,the average distance between the fourth transverse Iumbar artery and median sacral artery was(1.09±0.62)cm.The block time of lower abdominal aorta was 52-84 min.The bleeding during operation was 1000～4000 ml(average 2600 ml).The activity of T-SOD decreased during the period of reperfusion compared with the period of ischemia,and it was the lowest in 2 h after reperfusion.After operation,the skin temperature of lower limb was lower,and the color was pale.6-8 h later,it was relieved.The lower limb was a little swollen.Conclusion The gap between the third and the fourth transverse lumhar artery is suitable for lower abdominal aorta block.Temporary block of lower abdominaI aorta can alleviate the iniury caused by ischemia-reperfusion.