骶骨脊索瘤靶血管栓塞手术治疗及并发症分析.docVIP

骶骨脊索瘤靶血管栓塞手术治疗及并发症分析 作者：陈康武，杨惠林，陆俭，莫建强，王斌 作者单位：苏州大学附属第一医院骨科，江苏 苏州 【摘要】 目的 总结分析靶血管栓塞后手术治疗骶骨脊索瘤的疗效及并发症防治。方法 回顾性分析我院1996年 1月至2007年 1月22 例骶骨脊索瘤患者。本组均采用DSA下经导管栓塞双侧髂内动脉，骶正中动脉及肿瘤其他靶血管，栓塞后行后路手术治疗。随访其疗效并初步探讨并发症的发生及防治措施。结果 所有患者均顺利完成手术，无术中休克或死亡病例。术中平均出血1 206 mL(200～3 200 mL)，手术近期并发症有切口感染1 例，切口延迟愈合3 例，切口皮缘坏死5 例，9 例出现小便功能改变，8 例出现大便功能障碍。平均随访36个月(9～80个月)，死亡1 例，复发9 例，无转移病例。结论 术前经DSA下靶血管栓塞后行单纯后路手术可以完全切除骶骨脊索瘤，术中出血较少，相应的防治措施可以明显减少并发症的发生。 【关键词】 脊索瘤；骶骨；手术；栓塞；并发症 Clinical Analysis of Surgical Treatment after Transcatheter Arterial Embolization for Sacral Chordoma and Its Complications CHEN Kangwu，YANG Huilin，LU Jian，et al (Department of Orthopaedics，Frist Affiliated Hospital of Suzhou University，Suzhou 215006，China) Abstract：Objective To summarize and analysis the curative effect of surgical treatment after transcatheter arterial embolization for sacral chordoma and prevent its complications.Methods Twenty two cases of sacrum chordoma treated in our hospital were retrospectively analyzed from 1996 to 2007.Transcatheter arterial embolization was performed preoperatively in all cases，then using a posterior approach.Followup visit its curative effect and discussed the happening and prevention of complication.Results All cases were completed operation successfully，None of case shock or died during operation.Intraoperative blood loss ranged from 200 mL to 3200 mL(mean：1206 mL)，The postoperative early complications included wound infection in 1 case while delayed union in 3 cases，necrosis of the incision margin in 5 cases，leakage of cerebrospinal fluid in 1 case.Functional disturbance of urination occuerred in 9 cases and defecation in 8 cases.The average follow up visit time was 36 months，one case was died，nine cases have local recurrence，no metastasis case.Conclusion Posterior approach by performing the arterial embolization preoperatively can remove the sacral chordoma completely，decrease the blood loss.Effective prevention can obviously reduce the complications.