彩色多普勒超声引导下腹主动脉内球囊阻断术在骨盆和骶尾部肿瘤手术的应用研究

目的探讨彩色多普勒超声引导下实施腹主动脉内球囊阻断术的应用经验及在骨盆和骶尾部肿瘤手术中控制出血的应用价值。方法 20例骨盆或骶尾部肿瘤患者,在Philips4500型彩色多普勒超声引导下放置腹主动脉内球囊导管,并于术始放置食道超声于胃底持续监测肾脏血流,暴露肿瘤后充盈球囊,每次充盈小于100min,间歇15～30min,使手术在腹主动脉内球囊间断阻断下完成。结果 20例患者均成功放置腹主动脉内球囊导管。最小阻断注水量10～18(13.8±2.6)mL,累计阻断时间为45～180min,手术时间70～450(265±102)min,术中出血250～4000(1357±997)mL。最小阻断注水量(Y)与腹主动脉内径(X)回归方程:Y=7.1602X+2.9968(R2=0.7371,P<0.05)。术中持续食道超声监测未发现肾脏血流受阻情况。术后住院7～13(9.8±1.9)d,1例患者穿刺局部血肿形成,1年肿瘤复发率为10%。结论在彩色多普勒超声引导下可以简单准确地完成腹主动脉内球囊阻断术的实施。术中使用食道超声于胃底持续监测肾脏血流大大提高了球囊阻断术的安全性。采用彩色多普勒超声引导下腹主动脉内球囊阻断术可以减少骨盆及骶尾部肿瘤手术术中出血。

Appling the Color Doppler in Abdominal Aortic Balloon Occlusion for Pelvic and Sacral Surgery

Objective To apply the color Doppler in abdominal aortic balloon occlusion for pelvic or sacral surgery,and to evaluate its effectiveness in controlling blood loss.Methods A Philips4500 color Doppler was used to place abdominal aortic balloons in 20 patients with pelvic or sacral tumors who underwent surgery.The temporary abdominal aortic balloons were used for controlling blood loss in the surgery.Transesophageal echocardiography was performed to detect the renal blood flow.Results Abdominal aortic balloons were successfully placed to the 20 patients,with a water injection rate of 10-18(13.8±2.6) mL and a total of 45-180 min occlusion during the 70-450(265±102) min surgery.The intraoperative blood loss ranged from 250 to 4000(1357±997) mL.The water injection rate of abdominal aortic-balloons(Y) was correlated with the diameter of abdominal aorta(X): Y=7.1602X+2.9968(R2=0.7371,P<0.05).Renal blood flow was not affected.The patients stayed in hospital for 7-13(9.8±1.9) days after operation.One patient developed complications.The one year recurrence rate of tumors was 10%.Conclusion The color Doppler provides a simple and accurate instrument for abdominal aortic-balloon occlusion,with reliable blood loss control.