经皮射频消融术治疗复杂弥漫性动静脉畸形12例

Percataneous radio frequency ablation for complicated diffuse arteriovenous malformations： areport of 12 cases

目的评价射频消融术治疗复杂弥漫性动静脉畸形的临床效果与可行性。方法回顾性分析2014年12月至2016年12月临沂市肿瘤医院血管瘤特色专科经皮射频消融治疗的12例复杂动静脉畸形临床资料。病变面积10 cm×7 cm-28 cm×30 cm。在彩超引导下将射频消融针（电极）经皮穿刺至病变内血流信号最丰富的部位，采用阻抗自动调节模式，彩超实时监视下消融。深部病变中心区域消融功率90-110 W，较浅表或相对边缘病变消融功率60-80 W。每次消融治疗时间60-90 min，平均75 min。间隔3个月左右可重复下一次治疗。采用4级标准对治疗效果进行评价。结果1例患者前2次治疗后出现高热，2例患者术后出现一过性血红蛋白尿，1例出现瘤体原破溃区组织坏死，出现颊部洞穿性缺损，后行带蒂斜方肌肌皮瓣修复。7例合并出血者，治疗1次后出血均停止。随访1-3年，Ⅲ级（好）4例，Ⅳ级（优）8例。 结论彩超实时监测下，高功率、持续射频消融技术治疗动静脉畸形，能够彻底损毁深部核心病变，可有效控制危及生命的大出血，是介入栓塞、硬化、手术等治疗无效的复杂弥漫性动静脉畸形的有效替代疗法。

Objective To evaluate the efficacy and feasibility of radiofrequency ablation（RFA）for complicated diffuse arteriovenous malformations. Methods From Dec. 2014 to Dec. 2016, 12 cases with complicated diffuse arterioveneous malformations were treated by RFA in our hospital. The clinical records were retrospectively reviewed. The lesion size ranged from 10 cm x 7 cm to 28 cm x 30 cm. Ablation procedures with ＂ high power and long time＂ technique were performed under real time color Doppler monitoring. The impedance model were used and ablation needles were punctured into core lesions with the most abundant blood flow. Power was set as 90 to 110 W for central core lesions, and 60 to 80 W for superficial or surrounding lesions. The average ablation time was from 60 to 90 min （ average, 75 rain）. Next treatment would be performed 3 months later when neccessary. The therapeutic efficacy was evaluated on a 4-level scale. Results Hyperpyrexia occurred in 1 patients during first and second treatments. Transient postoperative hemoglobinuria occurred in 2 patient. Full thickness defects induced by tissue necrosis in the original ulcer area of cheek occurred in 1 patient, which was reconstructed with pedicle Trapezius muscle myocutaneous flap. Bleeding symptom in 7 cases stopped after only 1 treatment. After a follow-up period of 1 -3 years, the efficacy was graded as Ⅳ in 8 case, asⅢ in 4 cases. Conclusions For complicated diffuse arteriovenous malformations, radio frequency ablation with ＂ high power and long time＂ technique under real time color Doppler monitoring can completely damage the deep core soft lesions, and control the life-threatening hemorrhage effectively, which can be recommended as the alternative therapy when surgery, interventional embolizationor or sclerosant injection can not control the lesions.