腹主动脉球囊阻断技术在骨盆肿瘤切除术中的临床应用

目的:探讨应用经皮腹主动脉球囊阻断技术在骨盆肿瘤切除术中的临床应用价值。方法:根据术中控制出血方法的不同将47例骨盆肿瘤患者分为3组:术前介入靶血管栓塞组(A组)19例,腹主动脉球囊阻断加介入靶血管栓塞组(B组)12例,未行控制出血的对照组(N组)16例。比较3组手术时间、术中出血量、术中骶神经损伤、术中和术后休克死亡及术后1年复发等并发症情况。结果:A组和B组患者手术时间无明显差异,N组手术时间显著大于A组和B组(P<0.05);N组术中出血量和输血量显著大于A组和B组(P<0.05),B组小于A组,2组间差异有统计学意义(P<0.05)。B组未出见术后休克死亡、骶神经损伤及1年内复发等并发症,而A组的并发症发生率为10.5%(2/19),N组的发生率为31.2%(5/16)。结论:腹主动脉球囊阻断技术操作简便,腹主动脉球囊阻断并介入靶血管栓塞术可有效控制骨盆肿瘤切除术中的出血量,缩短手术时间,同时可以减少手术并发症、降低复发率,是一种十分有效、安全的方法。

Clinical application of temporary balloon of the abdominal aorta in pelvic tumors surgical operation

Objective：To evaluate temporary balloon of the abdominal aorta in pelvic tumors surgical operation as a useful adjuvant technique. Methods： Forty-seven patients with pelvic tumor collected from March 2004 to March 2009 were divided into 3 groups according to different methods of bleeding control： transcatheter arterial embolization before operation in 19 cases （group A）, temporary balloon of the abdominal aorta and transeatheter arterial embolization before operation in 12 cases （group B）, non-vessel controlled in 16 cases （group N）. The different methods were compared according to complications such as the loss of blood during the surgery, the whole surgery time, shock or death, sacral nerves injury, one-year relapse rate. Results： There was no obvious difference in operative time in group A and group B. The blood loss and the time of operations in group N was more than group A and group 13（ P d0.05）. The blood loss in group A was greater than group I3（ P d0.05）. These was no postoperative complication of shock or death, nerve injury and one-year relapse in group B. But the recurrence rate in group A was 10.5% （2/19）, and the group N was 31.2% （5/16）. Conclusion： The temporary balloon occlusion of abdominal aorta is easy to access, and can reduce intraoperative blood loss, operation time, complications and recurrence rate. It is a valuable technique, and makes the operation of sacral tumors much more safer than before.