腹主动脉内球囊阻断在骨盆及骶骨肿瘤切除重建术中的应用

Application of abdominal aorta blockade in pelvic sacral tumor resection and reconstruction

背景:目前,骨盆及骶骨肿瘤切除多采用术前肿瘤滋养血管栓塞、术中开腹结扎单侧、双侧髂内动脉或直接腹主动脉阻断、介入穿刺置管腹主动脉球囊阻断等手段减少出血,但前3种方法均增加手术创伤且控制出血效果不确切。目的:探讨腹主动脉内球囊阻断血流技术在骨盆及骶骨肿瘤患者切除重建术中的临床应用价值。方法:选取2010年5月至2017年4月收治的68例行骨盆及骶骨肿瘤根治性切除患者,随机分为对照组和阻断组各34例。对照组采用常规手术切除肿瘤,阻断组采用腹主动脉内球囊阻断血流技术进行常规手术切除肿瘤。结果:阻断组与对照组相比较手术时间明显缩短(P=0.015)、出血量显著减少(P=0.022)、术后复发率较低(P=0.029)。结论:腹主动脉内球囊阻断血流技术可有效提高骨盆及骶骨肿瘤患者手术的安全性及可靠性,具有较高的临床应用价值,值得临床上进一步推广使用。

Background： Currently, the methods for intraoperative blood loss reduction in the resection of pelvic sacral tumor include preoperative tumor vascular embolization, open ligation of the single side, bilateral internal iliac artery or direct abdominal aorta occlusion, interventional catheterization and abdominal aorta balloon occlusion, however, the first 3 ways will aggravate the surgical injury and their effects of bleeding control are not apparent. Objective： To investigate the clinical value of intra-abdominal aortic balloon occlusion in the resection and reconstruction of pelvic sacral tumors. Methods： Sixtyeight patients undergoing radical pelvic sacral tumor resection from May 2010 to April 2017 in our hospital were randomly divided into control group receiving traditional surgical method to remove the tumor and block group taking the intra-abdominal aortic balloon to block blood flow to perform surgery, with 34 patients in each group. Results： Compared with the control group, the operative time was significantly shorter（P=0.015）, the volume of blood loss was significantly reduced（P=0.022） and the postoperative recurrence rate was significantly lower in the block group（P=0.029）. Conclusions： The technology using intra-abdominal aortic balloon blocking blood flow can effectively improve the safety and reliability of the surgery, which shows high value in clinical practice, and is worthy of application.