球囊导管腹主动脉阻断在骶骨肿瘤术中的初步应用

The preliminary application of temporary balloon occlusion of abdominal aorta during resection of primary sacral tumors

目的 探讨和评估球囊导管腹主动脉阻断术控制骶骨肿瘤手术出血的价值和意义。方法对22例骶骨肿瘤患者术前行球囊导管腹主动脉阻断术。手术切开皮肤前充盈球囊,每次充盈时间持续45min,间歇10min,使肿瘤切除术的操作在腹主动脉血流暂时阻断的状态下顺利完成。结果 22例均一次性完成球囊导管腹主动脉放置,阻断成功率100％。后路骶骨肿瘤切除术中出血量为400～2000ml,平均出血量760ml,本组病例的肿瘤均被顺利切除,无一例因出血死亡,均未发生肾脏缺血或肾功能衰竭、脊髓或周围神经损伤、下肢缺血性损伤或下肢静脉血栓形成等并发症。结论 球囊导管腹主动脉阻断术操作简便、成功率高,阻断血流可靠,控制术中出血效果与肿瘤供血动脉栓塞基本相近,避免了动脉栓塞的并发症,进一步提高了手术安全性和成功率。

Objective To study the practical value and the clinical significance of hemorrhage control using temporary balloon occlusion of abdominal aorta during resection of sacral tumors. Methods The temporary balloon occlusion of abdominal aorta was used in 22 patients of sacral tumors. At the beginning of the operation, the predetermined volume of saline was injected to inflate the balloon. The balloons were inflated every 45 minutes with 10 minutes free interval and the operations were performed successfully under temporary abdominal aortic occlusion. Results The suc- cessful rate of occlusion in all 22 cases was 100%. The blood loss during posterior resection of sacral tumors ranged from 400ml to 2000ml, with an average of 760ml. All tumors were removed successfutly. None of the patients died of bleeding. There was no renal ischemia and renal failure occurred in all cases. There was no damage of spinal cord or peripheral nerves, no lower limb ischemia injury or deep vein thrombosis. Conclusion The temporary balloon occlusion of abdominal aorta was easy to access, with high successful rate and reliable effect of occlusion. It sharply reduced blood loss as much as selective arterial embolism, preventing the complications of arterial embolism, thus it made the operation much safer and more successful.