DSA超选择性动脉栓塞术在高位骶骨切除重建术前的应用

Application of DSA super-selective arterial embolization before high sacral resection and reconstruction

目的探讨数字减影血管造影(DSA)超选择性动脉栓塞术在高位骶骨切除重建术前的应用效果。方法收集2015年6月至2020年6月解放军总医院第一医学中心收治的20例骶骨恶性骨肿瘤患者的临床资料,全部患者均行高位骶骨切除重建术,且术前24 h内均行DSA超选择性动脉栓塞术。统计20例患者的肿瘤累及平面、手术方式、手术时间、术中出血量、术后病理情况及并发症发生情况。结果20例骶骨恶性骨肿瘤患者的骶骨肿瘤分区:Ⅰa区2例,Ⅰb区2例,Ⅰabc区3例,ⅠaⅡ区2例,ⅠabⅡ区4例,ⅠabcⅡ区2例,ⅠbⅡ区2例,ⅠbcⅡ区3例。平均手术时间(5.95±1.24)h;平均术中出血量(1815±675)ml。术后病理:脊索瘤8例,软骨肉瘤6例,骨肉瘤3例,血管内皮瘤2例,尤文肉瘤1例。术后并发症:腹股沟区血肿2例,伤口不愈合1例,臀部皮肤缺血坏死2例。结论在骶骨高位切除重建术前24 h内行DSA超选择性动脉栓塞术,具有手术时间短、术中出血量少、术后并发症少的优势,在高位骶骨切除术前准备中发挥重要作用。

Objective To investigate the clinical effect of digital subtraction angiography(DSA)super-selective arterial embolization before high sacral resection and reconstruction.Method The clinical data of 20 patients with sacral malignant bone tumors admitted to the First Medical Centre,PLA General Hospital from June 2015 to June 2020 were collected.All patients underwent high sacral resection and reconstruction,and DSA super-selective arterial embolization was performed within 24 hours before surgery.The cancer-affected plane,surgery method,surgery time,intraoperative blood loss volume,postoperative pathology,and complications of 20 patients were counted.Result All 20 cases with sacral malignant bone tumors were divided according to tumors delineation:2 cases in area Ia,2 cases in area Ib,3 cases in area Iabc,2 cases in area IaII,4 cases in area IabII,2 cases in area IabcII,2 cases in area IbII,and 3 cases in area IbcII.The average surgery time was(5.95±1.24)hours;the average intraoperative blood loss was(1815±675)ml.Postoperative pathology:8 cases of chordoma,6 cases of chondrosarcoma,3 cases of osteosarcoma,2 cases of hemangioendothelioma,1 case of Ewing’s sarcoma.Postoperative complications:2 cases of inguinal hematoma,1 case of nonhealing wound,2 cases of hip skin avascular necrosis.Conclusion DSA super-selective arterial embolization within 24 hours before high sacral resection and reconstruction has a shorter operation time,less intraoperative blood loss,and fewer postoperative complications than the traditional regimen.It plays an essential role in the preoperative preparation of high sacral resection.