动静脉畸形的治疗

Treatment for arteriovenous malformations

动静脉畸形(arteriovenous malformations,AVM)为高血流血管畸形,口腔颌面部软组织内及颌骨中均可发生。主要临床表现为病变区皮色改变、皮温增高伴搏动,听诊可闻及吹风样杂音;严重者可出现明显面部畸形,并可发生溃疡及出血。治疗方法主要为血管内栓塞或硬化及手术治疗。本文介绍了栓塞治疗的方法及注意事项,并根据软组织及颌骨AVM的血管构筑特点探讨了其治疗的要点与疗效。软组织AVM的治疗应首选血管内栓塞或硬化治疗,对于存在严重面部畸形的病例可结合手术治疗。对于颌骨AVM尤其是发生大出血的病例,栓塞后行颌骨刮治术疗效确切,可有效避免复发。

Arteriovenous malformations are high-flow vascular malformations, which might occur in both the soft tissue and jaw bone of oral and maxillofacial region. Clinical manifestations include skin discolorization with hyperthermia, pulsation and bruits of the involved area. Sometimes, AVMS might be associated with severe disfiguration, ulceration and bleeding. At present, embolotherapy, sclerotherapy, and surgical procedures are commonly used to deal with this intractable lesion. In this section, the technical aspects of embolo/sclerotherapy are introduced, and the main points of treatment and outcomes are discussed according to the angioarchitecture of the AVMs, both in soft tissue and in jaw. Generally, embolo or sclerotherapy should be the primary treatment for soft tissue AVMs, except when the lesion is associated with severe cosmetic problems. For a majority of central AVMs, superselective embolization and surgical curettage under hypotensive anesthesia is considered as the optimal treatment, particularly for those with episodes of severe bleeding.