Kitano Daiki, Osaki Takeo, Nakasone Mika, Nomura Tadashi, Hashikawa Kazunobu, Terashi Hiroto
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Int J Surg Case Rep. 2019;55:132-135. doi: 10.1016/j.ijscr.2019.01.018. Epub 2019 Jan 29.
Diffuse plexiform neurofibroma (DPN) in patients with neurofibromatosis type 1 (NF1) causes motility dysfunction in severe cases. Transcatheter arterial embolisation (TAE) is an effective haemorrhage control method in vascular tumour surgery.
We performed debulking surgery for DPN in the buttock and posterior thigh of two NF1 patients. Preoperative TAE with gelatine particles to tumour feeder vessels was conducted in both cases. Operative bleeding volumes were 500 and 4970 mL, respectively. In the latter case, the resection area extended to the upper poles of the buttocks, and the tumour invaded deeply into the surrounding tissues. Massive haemorrhage occurred, and internal iliac arterial balloon was inflated temporarily to further suppress the bleeding. Delayed wound healing due to TAE occurred; debridement and wound closure were required. Motor function improvement was confirmed in both patients.
Bleeding volumes varied because of highly developed collateral pathways and tumour invasiveness. As the upper pole of the buttock was perfused by the superior gluteal artery and its numerous collateral vessels, complete haemostasis was difficult despite adequate TAE. Because delineating the tumour border from the normal tissue was impossible due to the high tumour invasiveness, cutting into the hypervascular tumour was inevitable. As gelatine particles were absorbed but remained within the vessels, prolonged wound ischaemia and delayed healing occurred.
Although TAE with gelatine particles and balloon occlusion were reliable haemorrhage control methods in debulking surgery for lower limb DPN, optimal haemorrhage control technique, compatible with haemostasis and wound healing, was desired.
1型神经纤维瘤病（NF1）患者的弥漫性丛状神经纤维瘤（DPN）在严重情况下会导致运动功能障碍。经导管动脉栓塞术（TAE）是血管肿瘤手术中一种有效的出血控制方法。
我们对两名NF1患者臀部和大腿后部的DPN进行了减瘤手术。两例均对肿瘤供血血管进行了术前明胶颗粒TAE。术中出血量分别为500和4970毫升。在后一例中，切除范围扩展至臀部上极，肿瘤深入侵犯周围组织。发生了大量出血，临时充盈髂内动脉球囊以进一步控制出血。TAE导致伤口愈合延迟；需要进行清创和伤口缝合。两名患者的运动功能均有改善。
由于侧支循环高度发达和肿瘤侵袭性，出血量有所不同。由于臀上动脉及其众多侧支血管为臀部上极供血，尽管进行了充分的TAE，仍难以实现完全止血。由于肿瘤侵袭性高，无法将肿瘤边界与正常组织区分开来，则不可避免地要切入高血运肿瘤。由于明胶颗粒被吸收但仍留在血管内，导致伤口局部缺血时间延长和愈合延迟。
尽管在下肢DPN减瘤手术中，明胶颗粒TAE和球囊闭塞是可靠的出血控制方法，但仍需要一种与止血和伤口愈合相兼容的最佳出血控制技术。
