颌面部动静脉畸形的临床分型与治疗

The clinical classification and treatment of arteriovenous malformations of maxilloface

目的 探讨颌面部动静脉畸形 (arteriovenousmalformation ,AVM)的临床分型与治疗方法。方法 10 6例颌面部AVM患者根据病变表现特点分为四种类型 ,其中囊状扩张型 38例 ,局限增厚型2 2例 ,弥漫增厚型 4 2例 ,颌骨中心型 4例。 10 6例患者分别采用手术治疗 8例 (Ⅰ组 ) ,单纯供血动脉栓塞 2 3例 (Ⅱ组 ) ,供血动脉栓塞加瘤内硬化剂注射 37例 (Ⅲ组 ) ,供血动脉栓塞加瘤体切除 38例 (Ⅳ组 )。结果 全组病例随访 1～ 11年 ,Ⅰ、Ⅱ、Ⅲ、Ⅳ组的治愈率分别为 6 2 5 0 %、17 39%、89 19%、97 37%。 1例患者栓塞治疗时并发脑异位栓塞死亡。结论 新的临床分型有利于治疗方法的选择。优良的数字减影血管造影是颌面部AVM必不可少的决定性检查。单纯供血动脉栓塞仅能治愈单支终末供血的局限性病变 ,而多支动脉供血的病变单纯栓塞后容易复发。供血动脉栓塞加瘤内硬化剂注射或供血动脉栓塞加病变切除是颌面部AVM的有效治疗方法。

Objective To explore the clinical classification and ideal therapy for maxillofacial AVMs Methods According to the clinical characteristics,106 patients with maxillofacial AVMs were divided into the 4 types Of them,38 cases were cystic dilatation lesions,22 cases were limited thicken lesions,42 case were diffuse thicken lesions,4 cases were central maxillary hemangioma106 patients with maxillofacial AVMs were treated in our hospital,of them,8 cases received operation (group 1 ); 23 cases received embolization of supplying artery alone (group 2 ); 37 cases received embolization of supplying artery plus hardener intra- tumorous injection (group 3 );38 cases received embolization of supplying artery plus tumor resection (group 4) Results Of all the patients were followed up 1--11 years,In group 1,2,3,and4,the cure rates is 6250%,1739%,8919%,and 9737% respectivelyone patient died of embolization of abnormal communication branches between external carotid and intra-cranical arteries Conclusions (1) This newclinical classifiation is benificial for selecting method of treatment(2) It is necessary that a good digital subtraction angiography for maxillofacial AVMs(3) The embolization of tumor supplying artery alone could cure the small AVM with single branch terminal blood supply(4)The embolization of supplying artery plus hardener intratumorous injection or the embolization of supplying artery plus tumor resection is an efffective method for maxillofacial AVMs