无水乙醇栓塞治疗耳部动静脉畸形

Ethanol embolization of auricular arteriovenous malformations

目的介绍22例耳部动静脉畸形无水乙醇介入栓塞治疗的经验。方法对22例耳部动静脉畸形患者,通过局部穿刺或经导管内超选择径路达到耳部病变的异常血管团内,根据病变的血管团构筑,采用无水乙醇或稀释乙醇进行栓塞,间隔1个月进行电话随访,间隔3～4个月进行临床随访,根据临床检查或血管造影评价临床效果。结果22例患者共进行了38次无水乙醇栓塞,每次无水乙醇的用量为4～65 ml。9例病变局限患者,1～2次栓塞后达到临床治愈;13例病变广泛患者,无水乙醇栓塞3～5次后,溃疡愈合,出血停止,耳鸣消失或减弱。血管造影见9例异常血管团完全消失;8例血管团消失50%～75%;5例血管团消失小于50%。最常见的并发症为可逆性局部坏死和水疱形成。结论无水乙醇栓塞是耳部动静脉畸形安全、有效的治疗方式,并有可能成为首选的治疗方式。

Objective To present the authors’ initial experience of treating auricular arteriovenous malformations（AVMs） with ethanol embolization and to assess the clinical effectiveness of this therapeutic method.Methods Twenty-two patients with AVMs were enrolled in this study.Through local puncturing or super-selective catheterization the absolute ethanol,or diluted alcohol（based on the pattern of the AVMs）,was manually injected into the abnormal vascular plexus of the auricular lesion.The clinical results were estimated with physical examination or angiography at intervals of 3 ～ 4 month,and telephone questionnaire was made at monthly intervals for all patients.Results Thirty-eight ethanol embolization procedures were performed,the amount of ethanol used during the procedure ranged from 4 ml to 65 ml.After the treatment the clinical symptoms were improved,which were manifested as healing of the ulceration,stop of bleeding,disappearing or alleviation of tinnitus.Angiographic examination showed that the abnormal vascular lesion was completely vanished in 9 cases,decreased by 50%-75% in 8 cases and decreased less than 50% in remaining 5 cases.The common complications included irreversible local necrosis and vesiculation.Conclusion For the treatment of auricular AVMs ethanol embolization is an effective and safe method,which might become the therapy of first choice.