CAJ | 학술논문

目的探讨腹主动脉阻断球囊在骨盆肿瘤手术中的应用及其围手术期相关血管问题的处理.方法回顾性分析2005年12月至2010年4月期间265例骨盆肿瘤患者的资料.在行骨盆肿瘤手术前运用Seldinger法行股动脉置管,在肾下腹主动脉内留置球囊导管,肿瘤切除过程中,球囊完全阻断肾动脉以下腹主动脉主干血供,术后撤除球囊导管,保留股动脉鞘管6h.结果所有患者均成功应用腹主动脉阻断球囊,球囊阻断时间平均(66 ±4) min,未出现腹主动脉破裂和急性肾功能衰竭并发症.6例术后引流出血多,重新进手术窒进行术野造影诊断,其中3例行髂内动脉弹簧圈栓塞止血,1例行腰动脉弹簧圈栓塞止血,2例髂总动脉主干管壁破损出血,应用小覆膜支架封堵破口；6例术后出现穿刺侧股动脉血栓形成,1例出现双侧下肢动脉血栓形成,予以股动脉切开取栓恢复血运.2例出现股动脉穿刺点假性动脉瘤,予以缝合修补治疗,愈合良好. 结论腹主动脉阻断球囊对于减少骨盆肿瘤手术出血是有效的,使用过程应规范.对于围手术期出血和动脉血栓形成应有认识,及时处理.
목적 탐토복주동맥조단구낭재골분종류수술중적응용급기위수술기상관혈관문제적처리.방법 회고성분석2005년12월지2010년4월기간265례골분종류환자적자료.재행골분종류수술전운용Seldinger법행고동맥치관,재신하복주동맥내류치구낭도관,종류절제과정중,구낭완전조단신동맥이하복주동맥주간혈공,술후철제구낭도관,보류고동맥초관6h.결과 소유환자균성공응용복주동맥조단구낭,구낭조단시간평균(66 ±4) min,미출현복주동맥파렬화급성신공능쇠갈병발증.6례술후인류출혈다,중신진수술질진행술야조영진단,기중3례행가내동맥탄황권전새지혈,1례행요동맥탄황권전새지혈,2례가총동맥주간관벽파손출혈,응용소복막지가봉도파구；6례술후출현천자측고동맥혈전형성,1례출현쌍측하지동맥혈전형성,여이고동맥절개취전회복혈운.2례출현고동맥천자점가성동맥류,여이봉합수보치료,유합량호. 결론 복주동맥조단구낭대우감소골분종류수술출혈시유효적,사용과정응규범.대우위수술기출혈화동맥혈전형성응유인식,급시처리.
Objective To evaluate abdominal aortic balloon occlusion during pelvic tumors surgery and mamagement of related vascular complications. Methods We retrospectively analyze the clinical data of 265 pelvic tumor cases from December 2005 to April 2010.Before pelvic tumor operation,we place a sheath by Seldinger maneuvre in common femoral artery and send a balloon catheter in the abdominal aorta below the level of renal artery.The balloon catheter occluded the blood flow below the level of renal artery totally during the time of removing the tumors.After the procedure,we pull the balloon catheter out and normally retain the sheath for 6 hours. Results The procedure was successful in all cases and the average time of abdominal aorta blockade was (66 ± 4) min.There was no abdominal aortic rupture and acute renal dysfunction.Emergency angiography was performed on the operative region to diagnose the cause of massive bleeding after the open surgery in 6 cases.Among them,3 cases underwent embolization of internal iliac artery to stop bleeding and 1 case underwent embolization of lumber artery.Small covered stent was deployed in the common iliac artery to stop bleeding in 2 cases.Thrombosis of femoral artery at the puncture site occurred in 6 cases and bilateral thrombosis developed in 1 case. Blood flow was restowed to the femoral artery by open thrombectomy.Pseudoaneurysm formation around the puncture point occured in 2 cases and they underwent open surgical repair,then recovered well. Conclusions Balloon catheter occlusion of abdominal aorta is an effective method to control the hemorrhage in the pelvic tumors' operation.