口腔颌面部动静脉畸形诊治指南

The protocol of diagnosis and treatment guideline of oral and maxillofacial arteriovenous malformations

动静脉畸形(arteriovenous malformations,AVMs)是由于胚胎期脉管系统发育异常而导致动、静脉直接吻合所形成的血管团块,内含不成熟的动脉和静脉,而且血管团块中没有毛细血管,动静脉之间存在不同程度的直接交通。在血管瘤与血管畸形中,动静脉畸形相对少见,仅占1.5%左右,口腔颌面部是最好发的部位,占所有动静脉畸形的50%,其次是四肢和躯干。尽管动静脉畸形是先天性疾病,但仅有约60%是在出生时即被发现,其余在青春期或成年后才逐渐显现。病灶通常随身体发育而呈比例增长,可长期保持稳定,也可在短期内迅速增大,这种情况通常出现在外伤、青春期或孕期体内激素变化及不恰当的治疗,如病灶的次全切除、供血动脉结扎或堵塞之后。介入栓塞是目前主要的治疗方法,介入栓塞成功的关键是输送器进入异常血管团的中央以及选用可破坏血管内皮细胞的栓塞剂。本文参考国内外相关文献和诊治经验,制定口腔颌面部动静脉畸形治疗指南,希望对口腔颌面部动静脉畸形的规范治疗起到指导作用。本指南将及时予以更新,以反映和纳入最新研究成果,为广大患者提供最新治疗方案。

Arteriovenous malformations（AVMs） are congenital vascular anomalies featured by hypertrophied inflow arteries shunting through a primitive vascular nidus into tortuous dilated outflow veins.No intervening capillary bed is present.AVMs had lower rate of incidence,and accounted for 1.5% of all vascular anomalies.About 50% of the lesions were located in the oral and maxillofacial region.In spite of its congenital nature,60% of the lesions were noted after birth;the other lesions grow commensurately with the child and expand in the juvenile and adult.Trauma,partial resection,ligation of the feeding artery,hormonal swings during puberty and pregnancy may cause a lesion to rapidly expand.Interventional embolization is the primary modality of treatment for AVMs,and superselective placement at the AVM nidus and selection of appropriate agents to destroy the endothelial cellularity were essential points for success.Based on the published literatures and clinical experiences,we establish a diagnosis and treatment guideline in order to provide a criterion for the management of oral and maxillofacial AVMs.This protocol will be renewed and updated to include and reflect the cutting edge knowledge,and provide newest treatment modalities to benefit our patients.