小儿颌面部巨大血管瘤的介入治疗

Transcatheter arterial chemoembolization in the treatment of extensive maxillofacial hemangiomas in children

目的探讨小儿颌面部血管瘤的介入治疗经验，评价婴幼儿巨大颌面部血管瘤经动脉插管化疗栓塞治疗的安全性、技术成功率及临床疗效。方法回顾性分析2004年8月至2013年12月收治的婴幼儿颌面部血管瘤（瘤体最小直径〉5cm）患儿62例，采用供血动脉超选择性插管并以超液化碘油加平阳霉素行化疗栓塞，再以医用弹簧圈栓塞供血动脉主干，减少瘤体血供。其中47例接受了1次化疗栓塞，14例在3个月后接受了再次化疗栓塞治疗，1例接受了3次化疗栓塞。所有患儿在术后均获得随访，随访时间6～96个月。在术后6及12个月随访时检查患儿并评价疗效。结果动脉超选择性插管并化疗栓塞技术操作成功率为100％（78／78）；化疗栓塞后没有出现严重并发症，仅17例出现低热，经对症处理后17例均在7d内降至正常。介入术后肿瘤瘤体明显缩小，术前平均病变最小直径（8．5±0．5）cm与术后6个月（2．1±0．3）cm比较，差异有统计学意义（P〈0．05）。结论经病变供血动脉超选择性插管化疗栓塞治疗血管瘤安全性高、创伤小，并发症轻微、临床疗效显著，值得推广。

Objective To summarize the experiences of interventional treatment of maxillofacial hemangiomas and evaluate the effectiveness and therapeutic role of transeatheter arterial chemoembolization （TACE）. Methods Retrospective analyses were conducted for the clinical records of 62 children with maxillofaeial hemangioma treated between 2004 and 2013. And 28 boys and 34 girls were diagnosed as having extensive maxillofacial hemangioma based on clinical manifestations, color Doppler ultrasonography and computed tomography. 47/62 children underwent super-selective TACE once, 14/62 twice and 1/62 thrice. All children undergoing TACE were followed up for 6-96 months. Results After TACE treatment, all children had an excellent response and a successful disappearance of hemangioma without obvious complications. And the size of hemangioma body markedly decreased. There was no recurrence during a follow-up period of 6-96 months. Conclusions TACE is reliable, safe and efficacious in the treatment of extensive maxillofacial hemangioma in children.