骨盆肿瘤术前经导管动脉栓塞治疗的价值

Evaluation of Preoperative Transcatheter Arterial Embolization in the Treatment of Pelvic Tumors

目的 评价骨盆肿瘤术前局部动脉内灌注化疗和栓塞治疗的价值。资料与方法 术前栓塞治疗 4 8例骨盆肿瘤患者 (栓塞组 ) ,观察其临床改善情况 ,计算术中失血量和手术时间 ,并与 16例术前未栓塞骨盆肿瘤患者(对照组 )进行对照。结果 血管造影可清楚显示肿瘤的大小及血供特点 ,栓塞组术中失血量 2 177.1± 96 9.8ml,手术时间 198.9± 97.4min ;对照组术中失血量 4 4 6 2 .5± 1876 .8ml,手术时间 2 86 .4± 14 4 .5min。栓塞组均明显低于对照组 (P <0 .0 1)。手术时机的选择影响栓塞治疗的效果。组织学证实 :肿瘤均有不同程度的坏死、液化和囊性变 ,部分肿瘤有假包膜形成。结论 术前栓塞是骨盆肿瘤手术前最有效的辅助治疗手段 ,并且使手术易于操作。手术时机应选择在栓塞后

Objective To evaluate preoperative transarterial embolization in the surgical treatment of pelvic tumors.Materials and Methods The preoperative embolization was performed in 48 patients with pelvic tumors (study group). Another 16 patients with pelvic tumors who didn't receive preoperative embolization therapy were used as control group. Observation on the clinical manifestations after the procedure was made. The quantity of blood loss during the surgery and the whole surgery time were recorded. The results in two groups were compared with each other.Results Angiography clearly displayed the tumor feeding pattern and arterial size. The blood loss was 2177.1±969.8ml and 4462.5±1876.8ml in study and control group, respectively (P< 0.01). The surgical time in study group was 198.9±97.4min, which was significantly shorter than that in control group (286.4±144.5min, P<0.01). The interval duration between the embolization and surgery showed a certain relation with the effectiveness of embolization therapy. The blood loss and surgical time in the patients who received surgery within 6 days after the embolization procedure were significantly lower and shorter than those patients who received surgery after 7 days (P<0.01). Pathologically, necrosis, liquefaction, cystic degeneration and pseudo capsule formation of the tumor were found.Conclusion Preoperative embolization is the most effective adjuvant therapy for pelvic tumors before surgical management, which renders the surgical manipulation easier and simplifier. Surgery within 6 days after the embolization procedure is recommended.