选择性靶动脉栓塞治疗脊柱肿瘤的进展Advances of Treatments of Vertebral Tumor With Selective Target Arterial Embolization
程福平,杨述华,杜靖远
摘要(Abstract):
目的 :脊椎肿瘤以手术切除为首选方案 ,术中大出血 ,往往不能全部切除肿瘤 ,且术后死亡、并发症的发生率较高。术前选择性靶动脉栓塞为解决这一难题提供了一种有价值的新方法。方法 :用seldinger技术经股动脉选择性血管造影 ,逐支超选择性栓塞肿瘤靶动脉。结果 :成功的术前栓塞病例术中失血量明显减少 ,为 40 0~ 3 0 0 0ml。结论 :脊柱肿瘤术前选择性靶动脉栓塞可明显减少术中出血。本文对栓塞的手术时机选择、栓塞后并发症的预防和处理分别进行讨论。
关键词(KeyWords): 脊柱肿瘤;靶动脉栓塞;手术切除;失血
基金项目(Foundation):
作者(Author): 程福平,杨述华,杜靖远
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参考文献(References):
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