非肢体血管瘤手术中阻断血供的应用

APPLICATION OF BLOCKING VESSELS IN OPERATIVE THERAPY OF NON-LIMB HEMANGIOMA

目的 探讨非肢体血管瘤手术治疗时减少术中出血的方法。 方法 1998年11月～2 0 0 3年11月共收治非肢体血管瘤4 9例,其中男2 1例,女2 8例,年龄3个月～6 3岁。毛细血管瘤14例,海绵状血管瘤2 5例,蔓状血管瘤7例,混合性血管瘤3例。根据血管瘤的性质和不同部位选择不同阻断血供的方法。头面颈部蔓状血管瘤扪清搏动的滋养血管后,于其一侧血管约1cm处用7号丝线深缝一针,暂时缝扎致血管远端搏动消失再切除血管瘤;腹股沟及大腿上份蔓状血管瘤于瘤体组织近端腹股沟韧带上切开分离出髂总或髂外动脉、或在其远端切开分离出股动脉,通过无创血管夹阻断血流,再切除血管瘤;头面颈部、躯干部的毛细血管瘤及海绵状血管瘤瘤体周围用7号丝线间断缝扎,暂时阻断周围滋养血管,再切除血管瘤。 结果 通过阻断血供,血管瘤组织不同程度缩小,术中出血明显减少。术后均获随访6个月～4年,4 9例中4 7例完全愈合,无复发,外形满意,功能恢复正常。有2例因术后第2天出血行二次手术止血,术后伤口愈合,功能基本恢复正常。 结论 手术切除非肢体血管瘤之前阻断血供可明显减少术中出血,降低手术难度,为尽可能彻底切除血管瘤、减少复发创造了条件。

Objective To study the surgical method to reduce bleeding in treating hemangioma at non-limb sites. Methods From November 1998 to November 2003, 49 cases of non-limb hemangioma were treated, aged 3 months to 63 years, including 21 males and 28 females. There were 14 cases of capillary hemangioma, 25 cases of cavernous hemangioma, 7 cases of arterial racemose angioma and 3 cases of mixture hemangioma. According to the position and type of hemangioma, the various methods of blocking blood vessels were adopted to assist resect tumors. After the pulsatile artery was felt in arterial racemose angioma of neck and face by palpation, we sutured and knotted it with 7-0 silk string to block the bleeding. We found out the common iliac artery or external iliac artery or femoral artery and blocked them temporarily to resect arterial racemose angioma in inguen and thigh. We sutured and knotted vessel with 7-0 silk string to block the bleeding in capillary hemangioma and cavernous hemangioma of neck and face and truncus. Results Intraoperative bleeding obviously decreased and the tumor size reduced to various extent. Of the 49 cases, 47 cases achieved complete success, 2 cases bled within two days after operation. A postoperative follow-up of 6 months to 4 years showed that the appearance and function were satisfactory. Conclusion The preoperative method of blocking blood vessels obviously can reduce intraoperative bleeding and decrease operative difficulty, which makes it possible to eradicate hemangioma and lower recurrence rate.