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目的探讨选择性靶血管栓塞与球囊阻断2种方式对骶骨肿瘤术后患者伤口影响的比较。方法将104例骶骨肿瘤患者随机分为2组,术前行选择性靶血管栓塞(A组)53例,球囊导管腹主动脉阻断(B组)51例,其中20例患者术前已经行放、化疗。记录各组患者术中出血量、手术时间、术后引流量,观察2组患者术后伤口愈合情况。结果2组患者术中出血量、术后引流量相比差异无统计学意义(P>0.05),2组患者手术时间、引流时间相比差异有统计学意义(P<0.05)。A组皮肤红肿5例,愈合不佳8例,伤口窦道瘘口2例,皮肤坏死6例;皮肤大面积坏死2例;B组皮肤红肿1例,愈合不佳1例,伤口窦道瘘口1例;2组间比较,B组切口愈合不佳及皮肤坏死发生率高于A组,差异有统计学意义(P<0.05)。随访2组患者术后0.5、1、2年肿瘤复发率差异无统计学意义(P>0.05)。A组术后1例死亡、1例发生骶神经损伤,3例出现大小便功能障碍;B组术后无死亡,1例发生一过性神经症状,1例发生排尿功能障碍,术后1年左右恢复。结论球囊腹主动脉阻断可有效地控制骶骨肿瘤切除术中出血,与选择性靶血管栓塞相比对伤口影响更小。
Objective To investigate the effects of selective target vessel embolization and balloon occlusion on the wounds of sacral tumor patients after operation. Methods Totally 104 patients with sacral tumor were randomly divided into two groups: preoperative selective target vessel embolism (group A) 53 cases, balloon catheter abdominal aorta block (group B) 51 cases, of which 20 patients had preoperative Line release, chemotherapy. The intraoperative blood loss, operation time and postoperative drainage were recorded. The wound healing of the two groups was observed. Results There was no significant difference between the two groups in the amount of bleeding and the amount of drainage after operation (P> 0.05). There was significant difference between the two groups in the operation time and the drainage time (P <0.05). A group of skin irritation in 5 cases, poor healing in 8 cases, 2 cases of wound sinus fistula, skin necrosis in 6 cases; skin necrosis in 2 cases; B group skin irritation in 1 case, poor healing in 1 case, wound sinus fistula (P <0.05). There was a statistically significant difference between the two groups (P <0.05). The incision healing in group B and the incidence of skin necrosis were higher than those in group A (P <0.05). There were no significant differences in the recurrence rates of tumor between 0, 1, 2 years after follow-up in 2 groups (P> 0.05). One patient died in group A, one patient had sacral nerve injury and three patients had defecation dysfunction. There was no death after operation in group A, one patient had transient neurological symptoms, one patient had voiding dysfunction, About recovery. Conclusion Balloon abdominal aorta block can effectively control the bleeding during sacrectomy, which has less effect on wounds than selective target vessel embolization.