术前动脉栓塞在高位骶骨肿瘤手术中的疗效及并发症

Efficacy and complications of preoperative arterial embolization in the treatment of high sacral tumors

目的探讨术前动脉栓塞在高位骶骨肿瘤手术中的应用价值。方法回顾性分析37例于2006年1月至2011年12月,我院行手术治疗的高位骶骨肿瘤患者的病历资料。所有患者术前均行选择性动脉栓塞,后实施手术。通过回顾其介入操作记录、影像资料、手术记录、术后病程及护理记录单等,统计手术时间、术中出血量、输血量及术后并发症等情况。结果血管造影可显示肿瘤的血供、大小,栓塞后肿瘤血管和染色明显减少。术中见肿瘤体积有不同程度缩小,与正常组织界限变清,手术分离时出血相对减少。手术时间为(147.97±38.99)min,术中失血量为(1932.35±1293.27)ml,术中输血量(1296.00±938.00)ml。所有患者均未出现严重的栓塞相关并发症,切口延迟愈合发生率18/37(49%),切口感染发生率8/37(22%)。结论术前动脉栓塞是高位骶骨肿瘤手术的有效辅助手段,可缩短手术时间、减少术中出血及输血量;另一方面,栓塞可增加切口延迟愈合及感染的可能性。

Objective To investigate the efficacy and complications of preoperative arterial embolization in the surgical treatment of high sacral tumors. Methods The data of 37 patients with high sacral tumors who underwent surgical resection in our hospital between January 2006 and December 2011 were retrospectively analyzed. Preoperative arterial embolization were performed in all the patients and surgery were performed within the following 24 hours. The data of surgical time, blood loss, transfusion volume, and the postoperative complications were collected by reviewing the arterial embolization record, image, operation record, progress notes, nursing records and etc. Results Angiography clearly demonstrated the blood supply of the tumor and the dimension of the lesion. The tumor stain was markedly reduced after selective embolization in angiography. The volume of the tumor was decreased, the margin of the tumor became clear, and blood loss during the exposure was reduced. The surgical time was （ 147.97＋38.99 ） min, blood loss was （ 1932.35~1293.27 ） ml, transfusion volume was （ 1296.00＋938.00 ） ml. No serious embolization- associated complications were observed in all the patients. The incidence of delayed wound healing was 18/37 （ 49% ）, and the incidence of wound infection was 8/37 （ 22% ）. Conclusions Preoperative arterial embolization is an effective supplementary means for the surgery of high sacral tumor, which can shorten the surgical time, reduce the blood loss and the transfusion volume. Meanwhile, it could increase the possibility of delayed wound healing and wound infection.