术前栓塞在原发性腹膜后肿瘤中的临床应用

Application value of preoperative embolization in primary retroperitoneal tumor

目的评价原发性腹膜后肿瘤的供血动脉来源及其术前栓塞的价值。方法68例原发性腹膜后肿瘤患者按频数匹配原则随机分为常规对照组（35例）和术前栓塞组（33例）。常规对照组采用常规手术处理方法，术前栓塞组采用术前行肿瘤供血动脉栓塞治疗，比较两组患者的手术失血量、术中输血量、手术时间、住院时间和并发症发生等情况。分析腹膜后肿瘤的动脉供血来源，评估术前动脉栓塞对手术切除和患者预后的影响。结果原发性腹膜后肿瘤的供血动脉主要为腰动脉（81．8％）、髂内动脉（45．5％）和肾上腺动脉（27．3％）。术前栓塞组和常规手术组的平均术中出血量分别为912和2500ml，平均输血量分别为1000和2600ml，平均手术时间分别为4．1和5．9h，平均住院时间分别为12．5和19．8d，差异均有统计学意义（均P〈0．05）。结论原发性腹膜后肿瘤的动脉血供复杂，采用术前栓塞治疗，可明显减少术中出血量，减少切除术后并发症和住院时间，促进患者康复。

Objective To evaluate the value of angiography in clarifying the origin of the feeding arteries of primary retroperitoneal tumors and to explore the application of embolization therapy in the treating of primary retroperitoneal tumor. Methods 68 patients with primary retroperitoneal tumor were randomized into conventional tumor resection group （ n = 35 ） and the preoperative embolization group （ n = 33 ）. Some clinical data were compared between the preoperative embolization group and the routine operation group, including blood loss, blood transfusion, operation time and adverse reactions after embolization. All the diagnoses were pathologically confirmed. The origins of the tumor-feeding arteries were analyzed. The clinical value of embolization in assisting the surgery as well as in making prognosis was assessed. Results According to their location and size, primary retroperitoneal tumors had feeding arteries from different origins. In this series of cases the tumor blood supply originated from the lumbar artery （81.8%）, internal iliac artery （45.5%） and adrenal artery （27.3%）. In the preoperative embolization group and conventional surgery group, the blood loss was 912 ml vs. 2 500 ml （P〈0. 001）, the blood transfusion was 1 000 ml vs. 2 600 ml （P〈 0.001 ）, the operation time was 4.1 h vs. 5.9 h （P 〈0. 001 ）, and the length of hospital stay was 12.5 d vs. 19.8 d （ P 〈 0. 001 ）. Conclusions The origins of the feeding arteries in primary retroperitoneal tumors are very complex. Preoperative embolization therapy may effectively reduce the intraoperative blood loss, postoperative adverse events, length of hospital stay, and facilitate the patients＇ recovery.