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  

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

作　　者：李世德[1] 詹新立[1] 韦玮[1] 李剑[1] 

机构地区：[1]广西医科大学第一附属医院脊柱骨病外科,南宁530021

出　　处：《中华骨科杂志》2009年第11期1038-1042,共5页Chinese Journal of Orthopaedics

基　　金：基金项目：广西医疗卫生重点课题（重200839）,广西科技厅资助项目（桂科自0991113）

摘　　要：目的探讨暂时低位腹主动脉阻断技术用于骨盆、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，第四腰横动脉至骶正中动脉的距离。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、后不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、四腰横动脉的平均距离为（2．18±O．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52min，最长84main，平均（68．16±16．23）min。患者术中总出血量为1000-4000ml，平均2600ml。再灌注后0．5h和2h与缺血期比较，血中T-SOD活力均有不同程度降低，再灌注后2h降低最明显。解除阻断后双下肢皮温偏低、皮肤苍白，约6-8h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-再灌注损伤轻微。Objective To evaluate security of temporary block of lower abdominal aorta in the surgi- cal treatment of the patients with sacral or pelvic tumor. Methods 27 specimens were dissected. The dis- tance between the third and fourth transverse lumbar artery and the distance between the fourth transverse lumbar artery and median sacral 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 （T- SOD） and malondialdehyde （MDA） in the venous blood were studied during the different perioperative peri- ods. 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 lumbar artery and median sacral artery was （1.09±0.62） cm. The block time of lower abdominal aorta was 52-84 rain. The bleeding during operation was 1000-4000 ml （average 2600 ml）. The activity of T-SOD decreased during the period of reper- fusion 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 lumbar artery is suitable for lower abdominal aorta block. Temporary block of lower abdominal aorta can alleviate the injury caused by ischemia-reperfusion.

关 键 词：主动脉 腹 骨盆 骶骨 肿瘤 

分 类 号：R686[医药卫生—骨科学]