两种阻断方式对骶骨肿瘤切除术后伤口影响的比较  

Comparation effect to incision of selective target artery embolization and abdominal aorta temporary balloon occlusion for blocking blood in sacrum tumor resection

作　　者：孔金海[1] 肖辉[1] 孙正望 许炜[1] 刘铁龙[1] 宋滇文[1] 严望军[1] 钱明[1] 杨成[1] 杨兴海[1] 吴志鹏[1] 黄权[1] 林在俊[1] 钟南哲 肖建如[1] 

机构地区：[1]第二军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《脊柱外科杂志》2015年第1期37-40,共4页Journal of Spinal Surgery

摘　　要：目的探讨选择性靶血管栓塞与球囊阻断2种方式对骶骨肿瘤术后患者伤口影响的比较。方法将104例骶骨肿瘤患者随机分为2组,术前行选择性靶血管栓塞(A组)53例,球囊导管腹主动脉阻断(B组)51例,其中20例患者术前已经行放、化疗。记录各组患者术中出血量、手术时间、术后引流量,观察2组患者术后伤口愈合情况。结果2组患者术中出血量、术后引流量相比差异无统计学意义(P>0.05),2组患者手术时间、引流时间相比差异有统计学意义(P<0.05)。A组皮肤红肿5例,愈合不佳8例,伤口窦道瘘口2例,皮肤坏死6例;皮肤大面积坏死2例;B组皮肤红肿1例,愈合不佳1例,伤口窦道瘘口1例;2组间比较,B组切口愈合不佳及皮肤坏死发生率高于A组,差异有统计学意义(P<0.05)。随访2组患者术后0.5、1、2年肿瘤复发率差异无统计学意义(P>0.05)。A组术后1例死亡、1例发生骶神经损伤,3例出现大小便功能障碍;B组术后无死亡,1例发生一过性神经症状,1例发生排尿功能障碍,术后1年左右恢复。结论球囊腹主动脉阻断可有效地控制骶骨肿瘤切除术中出血,与选择性靶血管栓塞相比对伤口影响更小。Objective To evaluate the effect to incision of the selective target artery embolization and the abdominal aorta temporary balloon occlusion for blocking blood in sacrum tumor resection. Methods A total of 104 cases with sacrum tumor were divided into 2 groups randomly,53 cases were adopted with target artery embolization preoperation（ Group A）,while 51 cases used the temporary balloon occlusion of abdominal aorta to control the bleeding in operation（ Group B）. The blood volume,operation time,drainage were recorded. And 20 cases were performed with radiotherapy or chemotherapy before operation. The heal of the incision were observed. Results The blood volume and drainage of 2 groups had no statistical significance（ P〉0. 05）. The operation time and drainage time of 2 groups had statistical significance（ P〈0. 05）. Five cases with inflammation,8 cases with undesirable healing,2 cases with sinus or orificium fistulae,6 cases with cutaneous necrosis and 1case with large acreage of the skin were in Group A. One case with inflammation,1 case with undesirable healing,1 case was with sinus or orificium fistulae and 1 case with cutaneous necrosis were in Group B. Conpared with Group A,Group B had higher incidence rate of undesirable healing and cutaneous necrosis,the difference had statistical significance（ P〈0. 05）. The difference of recurrence rate in 0. 5,1,2 years of 2 groups had no statistical significance（ P〈0. 05）. One dead case,1 case with sacral nerve injured,3 cases with dysfunction of the bowels were in Group A. No dead case was in Group B,1 case was suffered with temporary nerve syptoms,1 case was suffered with dysfunction of the urination and recovered in 1 year. Conclusion The temporary balloon occlusion of abdominal aorta can control the bleeding of the operation sufficially in the resection of the sacrum tumor. And it has less complication of the incision necrosis than the selective target artery embolization.

关 键 词：骶骨 脊椎肿瘤 伤后愈合 气囊阻塞 血管 栓塞 治疗性 

分 类 号：R739.42[医药卫生—肿瘤]