腰骶部骨肿瘤的介入性动脉栓塞治疗

【摘要】  目的 探讨选择性腰动脉及髂动脉栓塞及化疗栓塞在腰骶部肿瘤中的价值。方法 采用选择性动脉插管，用经高温处理的明胶海绵栓塞或化疗性栓塞供应肿瘤的腰动脉、髂内动脉。结果 本组共6例，2例骨巨细胞瘤栓塞后行手术治疗，术中出血量明显减少，平均为1 600 ml，且手术顺利，肿瘤切除彻底；2例血管瘤及2例转移瘤行栓塞及化疗栓塞，肿瘤缩小，症状明显减轻，生活质量提高，延长了生存期。结论 在腰骶部骨肿瘤中，选择性腰动脉加髂内动脉栓塞及化疗栓塞是一种安全有效的治疗方法。

【关键词】  腰骶部；骨肿瘤；动脉栓塞

　　Arterial Embolization and Chemoembolization in treatment of Sacrolumbar Bone Tumor

　　　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，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

　　1?1  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。