不同控制出血方法在骶骨肿瘤切除术中的应用价值比较

Comparative study of the different methods to control bleeding during the resection of sacrum tumor

目的:探讨骶骨肿瘤手术中应用不同方法控制出血的效果及其实用价值。方法:将143例骶骨肿瘤患者根据术中控制出血方法的不同分为6组,术前介入靶血管栓塞(A组)12例,髂内动脉结扎(B组)71例,球囊导管腹主动脉阻断(C组)9例,单纯低位腹主动脉阻断(D组)5例,低位腹主动脉阻断加髂内动脉结扎(E组)25例,未行控制出血的对照组(N组)21例。记录各组术中出血量,观察各组术中骶神经损伤、术中和术后出现休克死亡及术后1年复发等并发症情况。结果:各组术中出血量分别为N组5400±1756ml、A组3200±1060ml、B组3600±1146ml、C组1600±570ml、D组1650±540ml、E组1500±471ml,N组术中出血量显著大于A组和B组(P<0.05);C、D和E组术中出血减少,与N、A、B组比较均有显著性差异(P<0.05);C、D组术中出血量无显著性差异(P>0.05);E组术中出血量最少,与C、D组比较均有显著性差异(P<0.05)。N、A组的并发症发生率分别为4/21、2/12,两者之间无明显差异(P>0.05);B组的并发症发生率为6/71,与N、A组比较均有显著性差异(P<0.05);C、D、E组均未出现休克死亡、骶神经损伤、1年内复发等并发症。结论:腹主动脉阻断可有效控制骶骨肿瘤切除术中出血,低位腹主动脉阻断并髂内动脉结扎术是一种更有效和安全的手段。

Objective：To study the effect and practical value of different methods to control bleeding during the resection of sacrum tumor.Method：143 patients with sacrum tumor were divided into 6 groups according to different methods to control bleeding：non-vessel controlled in 21 cases （group N）,transcatheter arterial embolization before operation in 12 cases（group A）,hypogastric artery ligation in 71 cases（group B）,temporary balloon occlusion of abdominal aorta in 9 cases （group C）,intermittent block of lower abdominal aorta in 5 cases （group D）,intermittent block of lower abdominal aorta and hypogastric artery ligation in 25 cases （group E）.The different methods were compared according to complications such as the loss of blood,shock or death,sacral nerves injury,one-year relapse rate.Result：The volume of bleeding in each group was as follows,5400±1756ml in group N,3200±1060ml in group A,3600±1146ml in group B,1600±570ml in group C, 1650±540ml in group D,1500±471ml in group E.The bleeding in group N was great,compared to group A and group B （P〈0.05）,the loss of blood could be reduced effectively in group C,group D and group E compared to group N,group A and group B（P〈0.05）,the volume of bleeding in group C was equivalent to group D（P〉0.05）,the loss of blood in group E was the least,especially compared to group C and group D（P〈0.05）. The occurrence of complications in group N and group A was no difference （P〉0.05）,4/21 in group N and 2/12 group A,while 6/71 in group B,the difference was significant compared to group N and group A （P〈 0.05） ,complications such as shock or death,sacral nerves injury and one-year relapse were not occurred in group C,group D and group E.Conclusion：Intermittent block of abdominal aorta is effective in controlling the bleeding during the resection of sacrum tumor,the technique of intermittent block of lower abdominal aorta and hypogastric artery ligation is more effectively,securely and economically.