选择性动脉栓塞在胸、腰段脊柱肿瘤治疗中的应用

Selective arterial embolization for the treatment of thoracolumbar spinal tumor

目的 探讨减少脊柱肿瘤切除术中出血及提高肿瘤切除彻底性的有效方法。 方法 1984年 6月～ 1997年 4月对 15例胸、腰段原发脊柱肿瘤 (巨细胞瘤 5例 ,恶性神经鞘瘤 2例 ,脊索瘤 1例 ,纤维黄色瘤 1例 ,恶性纤维组织细胞瘤 1例 ,骨母细胞型骨肉瘤 1例 ,Ewing肉瘤 1例 ,骨髓瘤 1例 ,平滑肌肉瘤 1例 ,非何杰金氏淋巴瘤 1例 )术前采用选择性节段性动脉栓塞 ,术中行病灶切除及脊椎重建 ,其中 8例采用一期椎体全切除。 结果 栓塞满意者 14例 ,栓塞后未发生相应的合并症。出血量为 4 0 0ml～ 3 0 0 0ml,平均 12 0 0ml。随诊 8个月～ 9年 ,平均 4 8 7个月。局部复发 3例 ,转移死亡3例。大小便障碍者 4例中 ,3例完全恢复 ,1例未恢复。肌力下降的 9例中 ,7例有明显改善。 8例有下肢感觉障碍者 ,6例基本恢复正常。 结论 脊柱肿瘤术前行栓塞并于栓塞后 2 4～ 4 8小时内手术 ,可以明显减少术中出血 ,缩短手术时间 ,术野清晰 ,有利于脊柱肿瘤的彻底切除。

Objective To decrease intraoperative blood loss during tumor resection. Methods Fifteen patients with primary thoraco lumbar spinal tumor [giant cell tumor (5 patients), malignant nerinoma (2), chordoma (1), fibrous xanthosarcoma(1),malignant fibrohistocytoma(1), osteosarcoma(1), Ewing sarcoma(1), myeloma(1), leimyosarcoma(1), Non Hodgkin diseases (1)] were treated by means of preoperative selective arterial embolization, tumor resection, and spinal reconstruction. Eight patients were subjected to total spondeylectomy in one stage. Results Fourteen patients showed satisfactory results after embolization. The volume of intraoperative blood loss ranged from 3?000?ml to 400?ml (average 1?200 ml). Follow up of the patients varied from 8 months to 19 years (average 48 7 months). Local recurrence happened in 3 patients; 3 patients died from metastasis. Three of 4 patients recovered from complete bowel movement and urination. Sevent of nine patients had musical strength improved. Six of 8 patients had recovery of the e sensation of the lower limbs. Conclusions Selective arterial embolization before operation followed by operation within 24 hours can reduce intraoperative blood loss, shorten operative time, and provide a clear operative field for tumor resection.