摘要
目的探讨骨盆、骶骨肿瘤切除术中应用腹主动脉球囊发生股动脉穿刺相关并发症的原因、预防及处理措施。方法回顾性分析2010年8月至2018年8月于北京大学人民医院骨肿瘤科接受腹主动脉球囊阻断下骨盆、骶骨肿瘤切除术的825例患者中,发生股动脉穿刺相关并发症的23例患者的临床资料。其中男性8例,女性15例,年龄(37.0±16.2)岁(范围:15~65岁)。骶骨肿瘤20例,骨盆肿瘤3例;右侧股动脉穿刺17例,左侧6例,均使用直径为11~12 F(1 F≈0.33 mm)的动脉鞘管置入腹主动脉球囊。分析患者术后股动脉穿刺相关并发症发生及处理情况。结果共18例患者术后出现急性股动脉血栓,占2.2%(18/825)。2015年前收治的349例患者在股动脉鞘管拔除后采用按压止血,其中12例(3.4%)发生急性股动脉血栓;2015年后手术的476例患者使用血管缝合器闭合股动脉伤口,6例(1.3%)发生急性股动脉血栓。18例患者均在48 h内行急诊切开取栓后治愈。术后发生腹膜后血肿和股动脉假性动脉瘤各1例,均通过再次手术治愈。术后随访(40±18)个月(范围:13~108个月),随访期间发现下肢动脉慢性缺血3例,其中2例股动脉侧支循环代偿良好,患者症状不明显,未予处理,另外1例症状较重,行股-股动脉耻骨上人工血管旁路术,术后症状明显改善。结论急性股动脉血栓是常见的股动脉穿刺相关并发症。优化腹主动脉球囊置入技术、使用血管缝合器闭合股动脉伤口,有可能进一步减少并发症发生。术后严密随访观察,有助于及时发现并处理并发症,以改善患肢功能,利于该技术的临床推广应用。
Objective To investigate the causes,prevention and treatment of femoral artery puncture related complications caused by the application of resuscitative endovascular balloon occlusion of the aorta(REBOA)in the resection of pelvic and sacral tumors.Methods Clinical data of 23 patients with femoral artery puncture related complications who received REBOA in the resection of pelvic and sacral tumors from August 2010 to August 2018 at the Musculoskeletal Tumor Center,Peking University People′s Hospital were retrospectively analyzed.There were 8 males and 15 females,with the age of(37.0±16.2)years(range:15 to 65 years).Arterial access via the Seldinger technique for REBOA was obtained in the right common femoral artery of 18 cases,and in the left of 6 cases.An arterial sheath with a diameter of 11 to 12 F(1 F≈0.33 mm)was used for the patient.The occurrence and treatment of postoperative complications were analyzed.Results Acute femoral arterial thrombosis occurred in 18 patients,which was managed by open repair 48 hours postoperatively.Among the 349 patients admitted before 2015 who received hemostasis by compression after femoral artery sheath removal,12 patients(3.4%)developed acute femoral artery thrombosis.While the 476 patients admitted after 2015 who used a percutaneous suture device to close the femoral artery wound,6 patients(1.3%)developed acute femoral artery thrombosis.One case of retroperitoneal hematoma and 1 case of femoral pseudoaneurysm were found and surgically fixed.Postoperative follow-up was(40±18)months(range:13 to 108 months).Three cases with chronic lower extremity ischemia were confirmed by Doppler ultrasonography during 1 to 5 years follow-up.Two of them had minimal symptoms and denied further treatment,while the other one received femoral-femoral artery bypass surgery to restore distal flow for pain and numbness relief.Conclusions Acute femoral arterial thrombosis is the most common femoral artery puncture.Technique refinement of REBOA,the use of percutaneous suture device and close fol
作者
赵志庆
董森
石惊天
梁海杰
燕太强
郭卫
杨荣利
汤小东
张学民
Zhao Zhiqing;Dong Sen;Shi Jingtian;Liang Haijie;Yan Taiqiang;Guo Wei;Yang Rongli;Tang Xiaodong;Zhang Xuemin(Musculoskeletal Tumor Center,Peking University People′s Hospital,Beijing 100044,China;Department of Vascular Surgery,Peking University People′s Hospital,Beijing 100044,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第9期737-743,共7页
Chinese Journal of Surgery
基金
首都卫生发展科研专项(2020-2-4085)。
关键词
骨肿瘤
手术后并发症
腹主动脉球囊
骨盆肿瘤
骶骨肿瘤
Bone neoplasms
Postoperative complications
Resuscitative endovascular balloon occlusion of the aorta
Pelvic tumor
Sacral tumor
