双侧髂内动脉栓塞在骨盆肿瘤化疗栓塞中的临床应用

Tne clinical application of embolization of bilateral internal iliac arteries in chemoembolization of pelvic tumors

目的 :探讨双侧髂内动脉栓塞在骨盆肿瘤化疗栓塞中的临床应用价值。方法 :对 2 3例骨盆肿瘤患者采用Co bra或Yashiro导管进行超选择插管 ,找出肿瘤的所有供血动脉 ,然后根据血供进行超选择性灌注化疗 ,并用明胶海绵随机对其中 11例患者进行所有肿瘤供血动脉的选择性栓塞 (单纯栓塞组 ) ;对其中 12例患者除进行所有肿瘤供血动脉的选择性栓塞外 ,还对双侧髂内动脉主干进行栓塞 (双侧髂内动脉栓塞组 ) ,栓塞后 2 4～ 4 8h由同一组医生进行手术 ,计算术中出血量与手术时间。结果 :双侧髂内动脉栓塞组手术中暴露肿瘤的出血量为 80± 2 6 6 3ml,术中总出血量为 775± 2 35 97ml,手术时间为 16 4 17± 2 6 4 4min ;单纯栓塞组上述指标分别为 2 0 0± 4 8 5 8ml、176 3 6 4± 390 5 7ml、2 2 8 18± 37 37min。双侧髂内动脉栓塞组明显少于单纯栓塞组 (P <0 0 0 1)。手术中术野更清楚 ,易剥离 ,出血少 ,缩短手术时间。术后随访 6～ 18个月未见肿瘤复发和转移。结论 :双侧髂内动脉栓塞法能有效减少骨盆肿瘤的术中出血 ,利于肿瘤彻底切除 ,结合化疗能减少肿瘤复发或转移 。

Objective:To study the clinical application of embolization of bila teral internal iliac arteries in chemoembolization of pelvic tumors. Methods:Sel ective intubation were performed in 23 cases of pelvic tumors by Cobra or Yashir o catheter. All blood supply artery were found and selective chemoembolismed.the main stem of bilateral internal iliac arteries were embolismed with gelfoam in 12 of 23 cases randomly. Resection was performed by same surgeons in 24～48hours after chemoembolization. The hemorrhage volume and surgical time were counted. Results:The blood loss in tumor exposur e was 80±26 63ml.The total blood loss during operation was 775±235 97ml. The surgical ti me in bilateral embolization group was 164 17±26 44min, which was significant ly shorter than that in single embolization group.The tumors were easier to exci sion during the operation, less bleeding and operation time because of the bette r known operation-range in bilateral embolization group than in single emboliza tion group,the disease did not recur and metastasize during the 6～18 months' s follow-up.Conclusion:The blood l oss in operation of pelvic tumors is greatly r educed by bilateral embolization, which is an effective and safe technique, it c an increase removal proportion of the pelvic tumor and prevent recurrence or met astasis.