儿童医源性创伤后动静脉瘘的介入治疗

Interventional embolization of iatrogenic post-traumatic arteriovenous fistula in children

目的:探讨采用介入栓塞治疗儿童医源性创伤后动静脉瘘的临床效果及安全性。方法:3例创伤后动静脉瘘患儿,均经超声、CTA检查确诊为动静脉瘘,均采用介入治疗:术中将2.7F微导管插至瘘口部位,以弹簧圈及无水乙醇实施封堵。术中复查股动脉造影确认瘘口是否完全栓塞,残余瘘口以无水乙醇补充栓塞至瘘口完全闭塞。随访6个月~2年,观察临床症状及体征改变。结果:动脉造影可以清楚显示瘘口及静脉血流情况。3例患儿均可见单一瘘口及股静脉闭塞。3例患儿共施行3次栓塞治疗。术后所有病例未出现弹簧圈移位、皮肤坏死、肢体功能障碍及心脑肾严重并发症,术后1个月门诊复查患儿临床症状均得以改善。术后随访6个月~2年,3例均已达临床治愈标准,l例虽仍伴盆部静脉曲张,但无明显进展。3例患儿日常活动均无异常。结论:介入栓塞是治疗儿童医源性创伤后动静脉瘘安全、有效的方法,值得临床推广应用。

Objective： To explore the safety and clinical effects of interventional embolization foriatrogenic post-traumatic arteriovenous fistula （AVF） in children. Methods： Three children with iatrogenic post-traumatic arteriovenous fistula had been confirmed by ultrasound and CTA, and all of them were treated with interventional embolization. All therapy was by the injection of coils or ethanol through. The clinical symptoms and sign changes of all patients were followed-up from 6 months to 2 years. Results ： Arteriographycould clearly demonstrate the blood flow of fistula and vein. In 3 patients , no major complications such as ectopic coil embolization tissue necrosis, peripheral nerve palsy or cardio -pulmonary collapse were found. After interventional embolization therapy for 3 times , the clinical symptoms were under control. In the follow up of 6 months to 2 years, 3 cases were clinically cured, l patient was still with pelvic varices , but no significant progress, and there was no abnormality in daily activities in 3 cases. Conclusion： Interventional embolization for iatrogenic post-traumatic AVF is a safe and effective therapeutic method for AVF in children and is worthy of clinical application.