术前经动脉栓塞脊柱骨巨细胞瘤

目的评价经动脉栓塞治疗脊柱巨细胞瘤（GCT）的临床效果,分析栓塞技术并评价其安全性。方法回顾分析我院2002—2010年共23例（男8例,女15例）脊柱GCT患者,平均年龄29.4岁。栓塞治疗采用PVA颗粒（200～500μm）,2例加用明胶海绵,回顾手术报告评价术中出血。结果 21例患者达到完全栓塞,2例部分栓塞。根髓动脉（RMA）与肿瘤血管共蒂减少了完全栓塞的可能性。23例中9例患者肿瘤同时有RMA供血。完全去血管化患者术中平均出血1950ml,2例部分栓塞患者术中平均出血4800ml,栓塞过程中未出现永久并发症。结论血管造影识别并保护RMA可降低栓塞的风险。术前栓塞脊柱多血管GCT安全、有效,并有助于肿瘤切除。

Preoperative arterial embolization for spinal giant-cell tumors

Objective To estimate the clinical outcome of arterial embolization for patients of spinal giant cell tumor（GCT）,and to analyze its technique and safety.Methods Clinical records of 23 patients with spinal GCT（8 male and 15 females）with an average age of 29.4 years underwnt arterial embolization from 2002 to 2010 were evaluated retrospectively.Arteries were embolized with polyvinyl alcohol（PVA）particles（200—500 μm）,and pieces of gelatin sponge were added in 2 of 23 patients.Surgical reports were reviewed in terms of estimating blood loss.Results Total embolization was achieved in 21 patients,while 2 tumors were partially embolized.A shared vascular pedicle between radiculomedullary artery（RMA）and tumor diminished the likelihood of complete embolization.In 9 of 23 patients,the tumor vessel and RMA shared the same blood supply.In patients with complete devascularization,the mean intraoperative blood loss was 1950 ml,whereas in the 2 patients who were partially emboliazed was 4800 ml.No permanent complications occurred during embolization procedures.Conclusion Angiographic identification and protection of RMA vessels are essential in reducing the risk of embolizing.Preoperative embolization of spinal hypervascular GCT is safe,effective and helpful in tumor resection.