骨盆和盆腔肿瘤无血手术技术的临床应用

Clinical application of bloodless surgery technique for patients with pelvic tumor

目的比较低位腹主动脉球囊阻断技术与常规方法在复杂盆腔手术中的应用,探讨低位腹主动脉球囊阻断技术控制这类手术大量失血的临床应用价值。方法1991—2007年间复杂骨盆、盆腔肿瘤手术患者39例,按入院时间先后分为两组,2000年前为对照组,共26例,采用常规手术、麻醉;2000年后为球囊阻断组,共13例,术中采用低位腹主动脉球囊阻断技术。记录两组病例的手术时间、术中失血量、输血量、手术前后血电解质、肾功能和凝血功能的变化,同时观察术后缺血性并发症。结果两组患者手术时间无明显差异,球囊阻断组术中出血量和输血量分别为(391±297)m l和(430±319)m l,明显少于对照组的(2 289±1 602)m l和(2 066±1 050)m l(P<0.01)。对照组术前、术后血电解质、肾功能无明显变化,术后PT、APTT较术前明显升高,纤维蛋白原显著降低(P<0.05);球囊阻断组术前、术后血凝常规、血电解质和肾功能变化不明显。两组患者均未见缺血相关并发症。结论在复杂盆腔手术中应用低位腹主动脉球囊阻断技术能更有效控制术中出血,对凝血功能影响更小,便于手术操作,有极好的临床应用价值。

Objective To study the clinical application of lower abdominal aorta balloon block in controlling blood loss for complicated pelvic operations to compare with conventional technique. Methods Thirtynine patients with complicated pelvic operations from 1991 to 2007 were divided into two groups according to admission time. Twenty-six cases before 2000 were performed by conventional surgery and anesthesia as control group, while thirteen cases after 2000 were performed by lower abdominal aorta balloon block technique as balloon block group. Operation time, the volume of bleeding and blood transfusion, changes of blood electrolyte, renal function, coagulation function before and after operation, and postoperative ischemic complications were recorded in two groups. Results The operation time had no difference between two groups. The volume of bleeding and blood transfusion in balloon block group were （391 ± 297 ） ml and （430 ± 319 ） ml respec- tively, which were lower significantly than those in control group [ （2 289 ± 1 602） ml and （2 066 ± 1 050） ml respectively] （P 〈0.01 ）. In control group blood electrolyte and renal function had no obvious differences before and after operation,while postoperative PT and APTT were significantly increased and fibrinogen sig-nificantly decreased. In the balloon block group there was no obvious differences in blood electrolyte, coagulation function and renal function before and after operation. All the patients in two groups had no ischemic complications. Conclusion In the treatment of complicated pelvic tumor operation, the lower abdominal aorta balloon block technique is superior in decreasing blood loss and having less influence on coagulation function. The technique of lower abdominal aorta balloon block is simple, effective, safe and convenient in patients with complicated pelvic tumor operations.