CT血管造影技术辅助下球囊临时阻断术在骨肿瘤手术中的应用  

APPLICATION OF TEMPORARY BALLOON BLOCKING TECHNIQUE IN BONE TUMORS SURGERY UNDER THE AID OF CT ANGIOGRAPHY

作　　者：方成[1] 胡永成[2] 黄洪超[2] 夏群[3] 陈晓鹏[1] 袁斌斌[1] 何鑫[1] 王鹏[1] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市天津医院骨肿瘤科 [3]天津市天津医院脊柱II科

出　　处：《中国修复重建外科杂志》2014年第10期1253-1258,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：天津市自然科学基金资助项目(12JCYBJC16400);天津市卫生局攻关项目(12KG121)~~

摘　　要：目的探讨CT血管造影（CT angiography,CTA）技术辅助下球囊临时阻断术在骨肿瘤手术中的应用价值。方法回顾分析2008年4月-2013年10月收治的36例骨肿瘤患者临床资料。男22例,女14例;年龄25-83岁,平均46岁。病灶部位：骶尾部17例,髂骨12例,耻骨5例,股骨近端2例。术前行CTA测量腹主动脉外径、髂总动脉外径以及低位肾动脉下缘与腹主动脉分叉之间距离,三维重建CTA标记低位肾动脉开口及腹主动脉分叉与脊柱椎体（骨性标志）解剖关系。根据观测结果选择合适型号的球囊以及指导术中球囊定位,均于球囊临时阻断术下彻底切除肿瘤。结果 CTA测量示腹主动脉外径为（1.545±0.248）cm,髂总动脉外径为（1.060±0.205）cm,低位肾动脉下缘与腹主动脉分叉之间距离为（10.818±1.165）cm。三维重建CTA示,低位肾动脉开口于L1椎体为主（16例,44.4%）,腹主动脉分叉于L4椎体为主（22例,61.1%）。术中均有效阻断腹主动脉血流;3例球囊充起后血压显著增高,1例拔出球囊后左足背动脉搏动减弱,均经对症处理后缓解。手术时间118-311min;术中出血量200-1800mL,21例患者输血,输血量400-1200mL;累积动脉阻断时间为40-136min。术后患者均获随访,随访时间5-44个月,平均21个月。术后3个月,按照Enneking提出的骨肿瘤外科治疗后功能评定标准,获优9例,良20例,可5例,差2例。术后10例出现大小便功能障碍,2例肿瘤复发,3例死亡。结论CTA及三维重建能精确测量髂总动脉外径、腹主动脉外径及低位肾动脉下缘与腹主动脉分叉之间距离,可指导球囊型号选择以及术中球囊定位。骨肿瘤术中应用CTA辅助下球囊临时阻断术可减少术中出血量,保持术野清晰,缩短手术时间,降低肿瘤复发率。Objective To study the value of CT angiography（CTA） in the surgical treatment of bone tumors with the temporary balloon blocking technique. Methods A retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years（mean, 46 years）. The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique. Results The CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was（1.545 ± 0.248） cm and（1.060 ± 0.205） cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was（10.818 ± 1.165） cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L1（16/36, 44.4%） and the abdominal aortic bifurcation mainly located at L4（22/36, 61.1%）. Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1 800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1 200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months（m

关 键 词：骨盆肿瘤 骶骨肿瘤 CT血管造影 球囊临时阻断术 

分 类 号：R816.8[医药卫生—放射医学]