腰骶部骨肿瘤的介入性动脉栓塞治疗
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| 时间：2009-02-25 16:35:53 来源： 作者： |
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Arterial Embolization and Chemoembolization in treatment of Sacrolumbar Bone Tumor
Wang Ning, Hu Min, Fan HongQi
(Department of Radiology, PLA 252nd Hospital, Baoding 071000, China)
Abstract： Objective To examine the value of selective iliolumbar arterial embolization and chemoembolization in the therapy of sacrolumbar tumor. Methods Selective arterial catheter was used, and gelatin sponge processed by high temperature or chemoembolization was used to embolize the iliolumbar and internal iliac artery which nourished the tumor. Results In the six case, two ones with osteoclastoma were treated by operation after embolization, whose hemorrhage amount was decreased obviously (mean=1600 ml), and the operation was successful. In two cases with hemangioma and two ones with metastaic tumor, tumors were reduced in size by embolision and chemoembolization and the patients' symptoms were mitigated clearly, and their life quality was improved and survival period was lengthened. Conclusion In the sacrolumbar bone tumor selective iliolumbar and chemoenbolization may serve as a secure and effective therapy.
Key words： bone tumor; arterial embolization
腰骶部骨肿瘤因其发病部位特殊常引起疼痛、压迫脊髓及神经根而导致肢体功能障碍甚至截瘫，对病人危害极大。治疗以外科手术及放、化疗为主，随着脊柱外科的发展，椎体切除加固定已成为治疗本病的有效方法，但由于病变部位较深，周围解剖复杂且血液循环丰富，使得手术操作复杂，术中出血量多，手术的难度和风险大，治疗十分困难。近年来，随着经导管动脉栓塞术（TAE）的开展，使肿瘤的临床治疗有了很大进步。我院通过对2例椎体骨巨细胞瘤、2例血管瘤、2例转移瘤介入性动脉栓塞或化疗性栓塞治疗的分析研究，探讨介入性动脉栓塞治疗对椎体骨肿瘤治疗的可行性和临床应用价值。
1 临床资料
11 一般资料
本组6例，男4例，女2例，年龄22~78岁，平均53岁。骨巨细胞瘤2例，分别位于腰4，5椎体累及附件；2例血管瘤，1例位于腰5，1例位于骶1；2例转移瘤（均为单椎转移），1例位于腰5，1例位于骶1。所有病例椎体均有膨胀性改变伴有不同程度压缩性骨折，不同程度疼痛伴有下肢感觉及功能障碍。所有病例术前均有影像资料（平片、CT、MR）定位，除2例转移瘤原发病灶诊断明确，其余4例均经术前穿刺活检或术后病理证实。
12 方法与结果
局麻下采用改良Seldinger法穿刺股动脉，选择性髂内动脉、腰动脉插管造影，了解肿瘤供应血管；或做腹主动脉造影，再逐支选择插管至所需栓塞的肿瘤供血动脉造影，证实导管位置且不含有供应脊髓的Adamkiewicz动脉时，缓慢注入由造影剂、抗生素及经高温处理的明胶海绵细颗粒（约0.5 mm×0.5 mm）混合的栓塞剂，待血流明显减慢时用明胶海绵条逐段栓塞大的分支，直至主干栓塞。 最后在腹主动脉分叉处近段再做造影， 以明确肿瘤供应血管全部被栓塞为止。对不宜手术的骨肿瘤行姑息化疗再栓塞， 其栓塞剂采用化疗药物和碘油乳剂及明胶海绵条栓塞。本组栓塞血管13支，术前栓塞2例，栓塞血管6支（分期栓塞），肿瘤供血较术前减少80%以上，行前、后路分期手术切除加椎体重建，手术顺利，肿瘤切除（瓜除）彻底，术中出血平均1 600 ml。2例血管瘤行明胶海绵栓塞，栓塞血管3支，栓塞后重复造影，肿瘤染色明显减少70%以上，2例转移瘤栓塞3支血管，化疗栓塞后肿瘤血供明显减少60%以上。上述6例患者临床症状明显减轻（特别是2例手术后患者更明显）。
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