骶骨肿瘤术前供血动脉栓塞的临床应用
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摘要
目的评估骶骨肿瘤供血动脉的来源及术前栓塞的价值。方法对42例骶骨肿瘤手术切除前24 h内以明胶海绵颗粒对供血动脉进行栓塞。肿瘤包括脊索瘤14例、神经鞘瘤8例、转移瘤7例、骨软骨肉瘤3例、骨肉瘤1例、骨巨细胞瘤5例、成血管细胞瘤1例、多发性骨髓瘤1例、血管肉瘤1例、成软骨细胞瘤1例。结果根据骶骨肿瘤的位置及大小不同,供血动脉来源不一致。42例造影提示肿瘤供血动脉有98支,其中右腰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、左骶外侧动脉9支、右骶外侧动脉11支、左髂腰动脉1支、右髂腰动脉6支、骶正中动脉1支、左臀上动脉10支、右臀上动脉8支、左臀下动脉10支、右臀下动脉8支、左阴部内动脉8支、右阴部内动脉6支。肿瘤染色均较术前减少75%以上,栓塞24 h内行肿瘤切除术,术中、术后24 h内出血量40~7 200 m L,平均(1 255.2±982.1)m L。所有肿瘤均顺利切除,无严重并发症。结论骶骨肿瘤血供来源复杂,术前充分栓塞供血动脉能有效减少术中出血,降低手术危险性,提高肿瘤手术切除率。
Objective To investigate the origins of tumor-feeding arteries of sacral tumors and to assess the clinical value of preoperative embolization of sacral tumor before surgical resection. Methods Percutaneous transcatheter embolization of tumor-feeding arteries with gelfoam particles was performed in 42 patients with sacral tumor 24 hours before its surgical resection. The lesions included chordoma(n =14),neurilemmoma(n=8), metastatic tumor(n=7), chondrosarcoma(n=3), osteosarcoma(n=1), giant cell tumor of bone(n=5), hemangioblastoma(n=1), multiple myeloma(n=1), angiosarcoma(n=1) and chondroblastoma(n=1). Results Depending on tumor's location and size, the origins of tumor-feeding artery of sacral tumors were different from one to another. Angiography of the 42 patients showed that a total of 98 tumor-feeding arteries were detected, including right second lumbar artery(n=1), left third lumbar artery(n=1), right third lumbar artery(n=3), left fourth lumbar artery(n=6), right fourth lumbar artery(n=8), left fifth lumbar artery(n=1), left lateral sacral artery(n=9), right lateral sacral artery(n=11), left ilio-lumbar artery(n=1), right ilio-lumbar artery(n=6), median sacral artery(n=1), left superior gluteal artery(n=10), right superior gluteal artery(n =8), left inferior gluteal artery(n =10), right inferior gluteal artery(n =8), left internal pudendal artery(n =8), and right internal pudendal artery(n =6). After embolization therapy, the tumor staining markedly decreased by more than 75% when compared with the pre-embolization angiographic manifestations. Surgical resection of sacral tumor was carried out within 24 hours after embolization. The amount of blood loss in operation and within 24 hours after surgery was(40-7 200) m L, with a mean of(1 255.2±982.1) m L. The tumor was successfully removed in all patients, and no serious complications occurred.Conclusion The origin of blood supply for sacral tumors is very complex. Sufficient embolization of tumor-feeding artery of sacral neoplasm before surgical resection can effectively reduce the amount of intraoperative blood loss, reduce the risk of operation and improve the resection rate of tumor.
Objective To investigate the origins of tumor-feeding arteries of sacral tumors and to assess the clinical value of preoperative embolization of sacral tumor before surgical resection. Methods Percutaneous transcatheter embolization of tumor-feeding arteries with gelfoam particles was performed in 42 patients with sacral tumor 24 hours before its surgical resection. The lesions included chordoma(n =14),neurilemmoma(n=8), metastatic tumor(n=7), chondrosarcoma(n=3), osteosarcoma(n=1), giant cell tumor of bone(n=5), hemangioblastoma(n=1), multiple myeloma(n=1), angiosarcoma(n=1) and chondroblastoma(n=1). Results Depending on tumor's location and size, the origins of tumor-feeding artery of sacral tumors were different from one to another. Angiography of the 42 patients showed that a total of 98 tumor-feeding arteries were detected, including right second lumbar artery(n=1), left third lumbar artery(n=1), right third lumbar artery(n=3), left fourth lumbar artery(n=6), right fourth lumbar artery(n=8), left fifth lumbar artery(n=1), left lateral sacral artery(n=9), right lateral sacral artery(n=11), left ilio-lumbar artery(n=1), right ilio-lumbar artery(n=6), median sacral artery(n=1), left superior gluteal artery(n=10), right superior gluteal artery(n =8), left inferior gluteal artery(n =10), right inferior gluteal artery(n =8), left internal pudendal artery(n =8), and right internal pudendal artery(n =6). After embolization therapy, the tumor staining markedly decreased by more than 75% when compared with the pre-embolization angiographic manifestations. Surgical resection of sacral tumor was carried out within 24 hours after embolization. The amount of blood loss in operation and within 24 hours after surgery was(40-7 200) m L, with a mean of(1 255.2±982.1) m L. The tumor was successfully removed in all patients, and no serious complications occurred.Conclusion The origin of blood supply for sacral tumors is very complex. Sufficient embolization of tumor-feeding artery of sacral neoplasm before surgical resection can effectively reduce the amount of intraoperative blood loss, reduce the risk of operation and improve the resection rate of tumor.
引文
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[10]赵玮,王伟中,陈莹,等.骶骨肿瘤27例供血动脉的血管造影研究[J].介入放射学杂志,2014,23:716-718.
[11]杨述华,刘通顺,肖宝钧,等.髂内动脉栓塞后切除骶骨肿瘤[J].临床骨科杂志,2004,7:127-129.
[12]章祖成,王继芳,文载律,等.骨肿瘤动脉栓塞后组织学初步观察[J].中华骨科杂志,1997,17:83-86.
[13]Gellad FE,Sadato N,Numaguchi Y,et al.Vascular metastatic1esions of the spine:preoperative embolization[J].Radiology,1990,176:683-686.
[14]Ma X,Wei S,Yang C,et al.Gelfoam embolization or125I seed implantation may be a more effective treatment than surgical treatment for giant benign sacral neurogenic tumors[J].World J Surg Oncol,2015,13:247.
[2]Chen KW,Zhou M,Yang HL,et al.Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors[J].Oncol Lett,2013,6:251-255.
[3]Waisman M,Kligman M,Roffman M,et al.Posterior approach for radical excision of sacral chordoma[J].Int Orthop,1997,21:181-184.
[4]陈文华,王祁,何忠明,等.术前肿瘤动脉栓塞联合术中腹主动脉球囊阻断在骶骨肿瘤切除术中的应用[J].介入放射学杂志,2012,21:212-215.
[5]Simpson AH,Porter A,Davis A,et al.Cephalad sacral resection with a combined extended ilioinguinal and posterior approach[J].J Bone Joint Surg Am,1995,77:405-411.
[6]宋献文,郭荻萍,徐万鹏,等.脊柱肿瘤的诊断和治疗(附95例临床分析)[J].中华骨科杂志,1983,3:32-35.
[7]Feldman F,Casarrella WJ,Dick HM,et al.Selective intraarterial embolizaton of bone tumors.A useful adjunct in the management of selected lesions[J].Am J Roentgenol Radium Ther Nucl Med,1975,123:130-139.
[8]叶华,贾雨辰,田建明,等.恶性骨肿瘤的介入治疗(附20例报告)[J].中华放射学杂志,1994,28:230-233.
[9]杨正强,黄健,朱纪吾,等.术前选择性髂内动脉栓塞治疗骨盆肿瘤[J].临床放射学杂志,2002,21:385-387.
[10]赵玮,王伟中,陈莹,等.骶骨肿瘤27例供血动脉的血管造影研究[J].介入放射学杂志,2014,23:716-718.
[11]杨述华,刘通顺,肖宝钧,等.髂内动脉栓塞后切除骶骨肿瘤[J].临床骨科杂志,2004,7:127-129.
[12]章祖成,王继芳,文载律,等.骨肿瘤动脉栓塞后组织学初步观察[J].中华骨科杂志,1997,17:83-86.
[13]Gellad FE,Sadato N,Numaguchi Y,et al.Vascular metastatic1esions of the spine:preoperative embolization[J].Radiology,1990,176:683-686.
[14]Ma X,Wei S,Yang C,et al.Gelfoam embolization or125I seed implantation may be a more effective treatment than surgical treatment for giant benign sacral neurogenic tumors[J].World J Surg Oncol,2015,13:247.