脊柱肿瘤术前动脉造影和栓塞的临床研究

The clinical study of SA and SAE for the preoperative treatment of spinal tumors

目的：通过选择性动脉造影了解脊柱肿瘤的血管造影表现和血供情况，通过选择性动脉栓塞结果的评估探讨影响脊柱肿瘤术前动脉栓塞和疗效的因素及并发症的防治措施。材料与方法： 45例脊柱肿瘤行 49例次 DSA检查和术前选择性动脉栓塞。男 28例，女 17例，平均年龄 44. 3岁 (18～ 78岁 )；恶性肿瘤 35例，良性肿瘤 10例。肿瘤位于骶尾部 27例、胸椎 9例、腰椎 7例、颈椎 2例。行选择性血管造影后用明胶海绵栓塞肿瘤供血动脉，于栓塞后 1～ 5天内进行手术。结果：①脊柱肿瘤主要 DSA表现为供血动脉不同程度增粗、不同程度的肿瘤染色。② 49次 SAE术共栓塞肿瘤血管 115根，除 2例因供血动脉发出脊髓根大动脉和 1例存在多支血供而仅作部分栓塞者外余肿瘤血管均完全栓塞。③ 24例肿瘤完全切除， 21例大部分切除， 3例部分切除， 1例未切除。④手术平均出血量为 1009ml(400～ 2500ml)，无 1例发生术中死亡或术后严重并发症。结论：①脊柱肿瘤详细的 DSA检查有助于治疗方案的制定和所有靶血管的显示。②仔细分析 DSA表现、改进栓塞技术是保证脊柱肿瘤术前动脉栓塞疗效和减少产生并发症的关键。

： Objective： To evaluate DSA features of blood supply in spinal tumors,to investigate the complications of SAE and factors that influenced the result of spinal SAE.Materials and Methods： Forty- nine DSA as well as SAE procedures in 45 cases of spinal tumors were performed with gelfoam one to five days before surgical operation.The tumors were located in cervical(2 patients),thoracic (9 patients),lumbar (7 patients) and sacrococcygeal vertebrae( 27 patients).Results:① Most tumors had the main DSA findings as enlargement of feeding arteries,obvious tumor stain,stricture and irregularity of vessels.② One hundred and fifteen feeding arteries were embolized.Forty- eight cases had their masses resected with significant reduction of blood loss(average 1009ml),in 24 cases the tumors were resected completely,in 24 had partial resection of the tumor and in 1 case tumor failed to be resected due to intraoperative bleeding.There were no serious complications in all these cases.Conclusion:Meticulous analysis of DSA features is of utmost importance in the treatment of spinal tumors.The key point is to ensure satisfactory results and to reduce complications of the preoperative SAE procedures before tumor resection.