手术治疗小儿先天性动静脉瘘的疗效观察

Clinical observation on the surgical treatment of congenital arteriovenous fistula

目的探讨小儿先天性动静脉瘘的手术治疗效果。方法本组共收治先天性动静脉瘘惠儿5例，均行动脉造影及多普勒超声检查，发现局限型2例，弥漫型3例，病变均发生于四肢。对5例惠儿行手术治疗，局限型行病灶切除，弥漫型扩大切除病变组织，缺损区域以游离皮瓣移植修复。结果5例患儿随访1～3年。2例局限型患儿中1例治愈，1例病情得到控制；3例弥漫型病变中，2例病情得到控制，1例病情持续进展且因并发症已行左上肢截肢手术。结论手术治疗可作为cAvF局限型的首选治疗方式，而弥漫型单纯采取手术治疗则具有较高的复发几率。尽管如此，小儿CAVF还应尽早治疗以防止肢体畸形及循环系统衰竭等严重并发症的发生。

Objective To discuss the efficacy of surgical management of （congenital arteriovenous fistula, CAVF） in children. Methods Five children with CAVF （ male 1, female 4） aging 4-10 years were reviewed. DSA and Color Doppler were performed on all patients. The lesion was local in 2 and diffuse in 3 cases. All of the lesions were located in the extremities. All cases were received operation including lesion resection in 2 local cases, extended resection and dissociative skin flap rehabilitation in 3 cases with diffuse lesions. Results All cases were followed- up from 1 to 3 years. Among the 2 localized lesions, 1 case was cured and 1 was under control. Among the 3 diffused lesions, 2 case was under control, the other case improved, and had amputation because of complication. Conclusion Even the surgical management of CAVF has highter recurrence rate, CAVF in children should be treated as early as possible to control the incidence of complication, as limb malformation or circulatory failure.