纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部动静脉畸形效果观察

Clinical observation of fibrin glue combined with pingyangmycin for the embolism and sclerotherapy of cervicofacial arteriovenous malformations

目的 :观察和评价纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部动静脉畸形的临床效果。方法 :2012年12月—2016年12月,选择22例面颈部动静脉畸形病例,应用纤维蛋白胶复合平阳霉素栓塞硬化技术进行治疗。其中15例患者给予单纯经皮穿刺直接注射治疗,2例患者除原发灶区经皮穿刺直接注射外,同时行面动脉注射治疗,6例患者栓塞硬化治疗完成后,手术切除病变区增厚的纤维结缔组织及残余病变。治疗后观察患者生命体征,体格检查、彩色多普勒超声及CT、CTA评价治疗效果。随访时间6~36个月(平均18个月)。结果:22例患者中,男17例,女5例;年龄19~74岁(平均28岁)。18例(81.8%)患者病变消退率大于90%,4例(18.2%)病变消退率大于50%。治疗过程中,部分患者出现皮肤发白或青紫色改变,提示组织缺血或回流受阻。1例患者额部出现皮肤浅层坏死,局部形成薄痂;2例患者出现唇黏膜浅溃疡,均自行愈合。随访发现,3例患者病变继续生长。结论:纤维蛋白胶复合平阳霉素栓塞硬化技术用于治疗面颈部动静脉畸形安全、有效,尤其对局限性扩张型动静脉畸形效果较好。

PURPOSE： To observe and evaluate the outcome of fibrin glue （FG） combined with pingyangmycin （PYM） for treatment of selected cervicofacial arteriovenous malformation （AVM）. METHODS： Twenty-two patients with cervicofacial AVM were chosen and treated by embolism and sclerotherapy of FG combined with PYM from December 2012 to December 2016. Of the 22 cases, 15 underwent a direct percutaneous puncture of the nidus and injection of FG combined with PYM solely; 2 underwent an injection of FG combined with PYM into the facial artery in addition to direct injection in lesion. Six underwent surgical excision of the redundant fibrous connective tissue and residual lesions after the embolism and sclerotherapy. To observe the vital signs and symptoms after treatments. The therapeutic effect was evaluated by physical examination, ultrasonography with Doppler, computed tomography （CT） scan, and CT angiography. The follow-up time was from 6 months to 36 months（mean 18 months）. RESULTS： Of 22 patients, 17 were male and 5 were female, ranging in age from 19~74 years（mean,28 years）. Eighteen of 22 lesions （81.8%） showed greater than 90% reduction, whereas another 4 （18.2%） exhibited greater than 50% reduction. Transient white or cyan purple alteration in the skin occurred during the course treatment, indicating tissue ischemia or obstruction of draining veins. Superficial skin necrosis occurred and thin crust formed in forehead of 1 patient, and superficial mucous ulcer occurred in 2 patients and healed on its own. Three patients were found to continue growth during follow-up. CONCLUSIONS： Application of fibrin glue combined with PYM for the embolism and sclerotherapy of selected cervicofacial AVM appears to be safe and effective. It offers broad prospects especially for the treatment of locally expanded AVM.