骶骨肿瘤血供特点及栓塞后术中出血的分析

Blood supply characteristics of sacral tumors and analysis of intraoperative hemorrhage after embolization

目的探讨骶骨肿瘤供血特点以及术前腰动脉栓塞在骶骨肿瘤切除术中止血的应用价值。方法纳入42例骶骨肿瘤患者,包括脊索瘤14例、神经鞘瘤8例、转移瘤7例、骨巨细胞瘤5例和其他肿瘤8例。采用血管造影观察骶骨肿瘤供血情况,对腰动脉供血的骶骨肿瘤用明胶海绵超选择性动脉栓塞,栓塞后24 h内行手术切除。结果42例肿瘤中有14例(33.3%)存在腰动脉供血,腰动脉供血与骶骨肿瘤大小相关(P=0.023)。对14例患者的20支腰动脉供血支(右腰2动脉1支,左腰3动脉1支,右腰3动脉3支,左腰4动脉6支,右腰4动脉8支,左腰5动脉1支)栓塞后,术中出血量为200~5000 mL,中位出血量1550 mL。结论术前超选择性腰动脉栓塞能有效地减少术中出血,降低手术危险性,提高肿瘤手术切除率,是十分有效的方法,可推广为临床术前操作标准模式。

Objective To investigate the blood supply characteristics of sacral tumors and to discuss the hemostatic value of preoperative lumbar artery embolization in sacral tumor resection.Methods A total of 42 patients with sacral tumors,including chordoma(n=14),chwannoma(n=8),metastasis(n=7),giant cell tumor of bone(n=5)and other tumors(n=8),were enrolled in this study.Angiography was performed to display the blood supply of sacral tumors.For sacral tumors receiving blood from the lumbar artery,superselective arterial embolization with gelatin sponge was performed,which was followed by surgical resection within 24 hours.Results Of 42 tumors,lumbar artery blood supply was found in 14(33.3%),and a significant correlation existed between the presence of lumbar arterial blood supply and the size of sacral tumor(P=0.023).Embolization of 20 lumbar artery branches supplying blood to sacral tumor was carried out,including right L2 artery(n=1),left L3 artery(n=1),right L3 artery(n=3);left L4 artery(n=6),right L4 artery(n=8),and left L5 artery(n=1).In subsequent surgery,the intraoperative blood loss was 200-5000 mL,with a median blood loss of 1550 mL.Conclusion In surgically treating sacral tumors,preoperative superselective lumbar artery embolization can effectively reduce intraoperative blood loss,reduce the risk of surgery and improve the surgical resection rate of tumor.Therefore,preoperative superselective lumbar artery embolization is a very effective method,and it should be popularized in clinical practice and used as the standard procedure of preoperative preparation.