APPLICATION OF TEMPORARY BALLOON BLOCKING TECHNIQUE IN BONE TUMORS SURGERY UNDER THE AID OF CT ANGIOGRAPHY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FANGCheng ¹ ,  HUYongcheng ² , HUANGHongchao ² , XIAQun ³ , CHENXiaopeng ¹ , YUANBinbin ¹ , HEXin ¹ , WANGPeng ¹

1. Graduate School, Tianjin Medical University, Tianjin, 300070, P. R. China;
2. Department of BoneTumor, Tianjin, 300070, P. R. China;
3. No.2 Department of Spine Surgery, Tianjin Hospital, Tianjin, 300070, P. R. China;

Corresponding?author：

HUYongcheng, Email: yongchenghu@126.com

Keywords：

Pelvic tumor; Sacrum tumor; CT angiography; Temporary balloon blocking technique

DOI：

10.7507/1002-1892.20140271

Video：

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Objective To study the value of CT angiography (CTA) in the surgical treatment of bone tumors with the temporary balloon blocking technique. Methods A retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years (mean, 46 years). The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique. Results The CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was (1.545±0.248) cm and (1.060±0.205) cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was (10.818±1.165) cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L₁ (16/36, 44.4%) and the abdominal aortic bifurcation mainly located at L₄ (22/36, 61.1%). Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1 800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months (mean, 21 months). According to Enneking standard, the results were excellent in 9 cases, good in 20 cases, fair in 5 cases, and poor in 2 cases at 3 months after operation. There were 10 cases of dysfunction of urination and defecation, 2 cases of tumor recurrence, and 3 cases of death after surgery. Conclusion CTA and three-dimensional reconstructions technique can accurately measure the external diameter of aortaventralis and arteria iliaca communis and the distance between low renal artery and abdominal aortic bifurcation and offer great help to choose appropriate balloon and locate the balloon during surgery. The balloon blocking technique under the assistance of CTA can obviously reduce intraoperative blood loss and tumor recurrence, supply a clear view in surgery and shorten the operation time.

Citation： FANGCheng, HUYongcheng, HUANGHongchao, XIAQun, CHENXiaopeng, YUANBinbin, HEXin, WANGPeng. APPLICATION OF TEMPORARY BALLOON BLOCKING TECHNIQUE IN BONE TUMORS SURGERY UNDER THE AID OF CT ANGIOGRAPHY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1253-1258. doi: 10.7507/1002-1892.20140271 Copy

1.	王學敏, 黃炎哲, 王愛忠, 等.超聲輔助下球囊導管阻斷犬髂總動脈或腹主動脈的可行性.中華麻醉學雜志, 2009, 28(9):863-864.
2.	曹際斌, 高思佳, 李燕燕, 等.無創性脊髓血管成像診斷脊髓血管畸形的臨床應用價值.中華放射學雜志, 2012, 46(5):430-434.
3.	肖繼偉, 王曉燕.64排CT冠脈序列擴大增強掃描診斷大血管疾病的臨床價值.江漢大學學報:自然科學版, 2012, 40(6):76-80.
4.	毛崇梅, 衣玲, 李勝.顱內動脈瘤不同影像技術診療效果比較.臨床醫學工程, 2012, 19(9):1433-1436.
5.	Enneking WF, Dunham W, Gebhardt MC, et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin Orthop Relat Res, 1993, (286):241-246.
6.	陳文華, 王祁, 何忠明, 等.術前腫瘤動脈栓塞聯合術中腹主動脈球囊阻斷在骶骨腫瘤切除術中的應用.介入放射學雜志, 2012, 21(3):212-215.
7.	唐順, 董森, 郭衛, 等.腹主動脈球囊阻斷控制骶骨腫瘤切除術中出血的效果.中國脊柱脊髓雜志, 2009, 19(2):85-89.
8.	Ullmark G, Hovelius L, Strindberg L, et al.Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery.Acta Orthop Scand, 2000, 71(1):51-54.
9.	鄭瑾, 孔健, 朱杰誠, 等.球囊導管腹主動脈阻斷術在骶骨腫瘤術中的并發癥及其預防.中國骨腫瘤骨病, 2004, 2(4):212-214.
10.	李世德, 詹新立, 韋瑋, 等.暫時低位腹主動脈阻斷用于骨盆、骶骨腫瘤切除術的安全性探討.中華骨科雜志, 2009, 29(11):1038-1042.
11.	Ozkan U, O?uzkurt L, Tercan F, et al.Renal artery origins and variations:angiographic evaluation of 855 consecutive patients.Diagn Interv Radiol, 2006, 12(4):183-186.
12.	Fernet M, Goldlust D, Salama J, et al.A case of ectopic right renal artery:a radiologic-anatomic variant.Surg Radiol Anat, 1987, 9(4):319-320.
13.	Zhang L, Gong Q, Xiao H, et al.Control of blood loss during sacral surgery by aortic balloon occlusion.Anesth Analg, 2007, 105(3):700-703.

1. 王學敏, 黃炎哲, 王愛忠, 等.超聲輔助下球囊導管阻斷犬髂總動脈或腹主動脈的可行性.中華麻醉學雜志, 2009, 28(9):863-864.
2. 曹際斌, 高思佳, 李燕燕, 等.無創性脊髓血管成像診斷脊髓血管畸形的臨床應用價值.中華放射學雜志, 2012, 46(5):430-434.
3. 肖繼偉, 王曉燕.64排CT冠脈序列擴大增強掃描診斷大血管疾病的臨床價值.江漢大學學報:自然科學版, 2012, 40(6):76-80.
4. 毛崇梅, 衣玲, 李勝.顱內動脈瘤不同影像技術診療效果比較.臨床醫學工程, 2012, 19(9):1433-1436.
5. Enneking WF, Dunham W, Gebhardt MC, et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin Orthop Relat Res, 1993, (286):241-246.
6. 陳文華, 王祁, 何忠明, 等.術前腫瘤動脈栓塞聯合術中腹主動脈球囊阻斷在骶骨腫瘤切除術中的應用.介入放射學雜志, 2012, 21(3):212-215.
7. 唐順, 董森, 郭衛, 等.腹主動脈球囊阻斷控制骶骨腫瘤切除術中出血的效果.中國脊柱脊髓雜志, 2009, 19(2):85-89.
8. Ullmark G, Hovelius L, Strindberg L, et al.Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery.Acta Orthop Scand, 2000, 71(1):51-54.
9. 鄭瑾, 孔健, 朱杰誠, 等.球囊導管腹主動脈阻斷術在骶骨腫瘤術中的并發癥及其預防.中國骨腫瘤骨病, 2004, 2(4):212-214.
10. 李世德, 詹新立, 韋瑋, 等.暫時低位腹主動脈阻斷用于骨盆、骶骨腫瘤切除術的安全性探討.中華骨科雜志, 2009, 29(11):1038-1042.
11. Ozkan U, O?uzkurt L, Tercan F, et al.Renal artery origins and variations:angiographic evaluation of 855 consecutive patients.Diagn Interv Radiol, 2006, 12(4):183-186.
12. Fernet M, Goldlust D, Salama J, et al.A case of ectopic right renal artery:a radiologic-anatomic variant.Surg Radiol Anat, 1987, 9(4):319-320.
13. Zhang L, Gong Q, Xiao H, et al.Control of blood loss during sacral surgery by aortic balloon occlusion.Anesth Analg, 2007, 105(3):700-703.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF TEMPORARY BALLOON BLOCKING TECHNIQUE IN BONE TUMORS SURGERY UNDER THE AID OF CT ANGIOGRAPHY

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