艾克刀联合平阳霉素在颌面部血管畸形治疗中周围神经保护作用临床研究

Peripheral nerve protection during the treatment for vascular malformations in maxillofacial region by using electrochemical therapy and pingyangmycin injection

目的探讨艾克刀联合平阳霉素治疗颌面部血管畸形过程中的周围神经保护作用,在保证治疗效果的同时避免神经损伤。方法回顾性分析2015年8月至2016年5月在中国医科大学附属口腔医院口腔颌面外科住院接受电化学治疗的血管畸形患者31例,血管畸形均位于腮腺区、眶下区、颏孔区及舌根部等距离知名神经较近部位。治疗过程中控制艾克刀通电时间和平阳霉素使用浓度,评价治疗效果以及对神经是否造成损伤。结果随访6~15个月,31例患者均有不同程度改善,治愈率74.2%。术后常发生肿胀、疼痛、发热等症状,2例患者术后出现面神经损伤症状,1例术前面部运动不对称患者术后症状得到缓解,2例出现眶下区麻木,2例出现下唇麻木。术后给予抗炎和激素治疗,口服甲钴胺,术后1~6个月除1例患者外,神经损伤症状均得到恢复。结论电化学治疗是治疗血管畸形行之有效的方法,在治疗过程中合理利用艾克刀和平阳霉素,可减少术后并发症的发生。

Objective To discuss the measures to protect the peripheral nerves during the treatment for vascular malformations in maxillofacial region by using electrochemical therapy and pingyangmycin injection.Methods We retrospectly analyze the chart of 31 patients with vascular malformation treated with electrochemical therapy in Stomatology Hospital of China Medical University from August 2015 to May 2016.All of the vascular lesions were at regions close to major nerves,such as parotid,infraorbital and mental foramen area,root of tongue and so on.We recorded conduction time and concentration of pingyangmycin intra-operatively,and the results were evaluated after treatment.Nerve injuries were also evaluated.Results All 31 patients were improved during the follow-up of 6 to 15 months with a cure rate of 74.2%.The most common complications included swelling,pain and fever.Two patients showed symptoms of facial nerve injury.One patient with pre-operative facial motor asymmetry showed improvement after treatment.Two patients showed numbness in the infraorbital region and 2 patients in lower lips.These patients received anti-inflammatory and hormone therapy and oral mecobalamin treatment.All patients recovered except one in 1 to 6 months.Conclusion Electrochemical therapy is effective in the treatment of vascular malformation.A proper use of electrochemical instrument and pingyangmycin can reduce the complications after surgery.