头面部动静脉畸形的治疗:根治性无水乙醇介入与手术的综合运用

Treatment of head and facial arteriovenous malformation with ethanol embolization and surgical resection

目的评价分别采用无水乙醇介入栓塞、单纯手术切除、手术+无水乙醇介入栓塞治疗头面部动静脉畸形的效果。方法回顾性分析2014年至2018年上海交通大学医学院附属第九人民医院整复外科血管瘤与脉管畸形中心治疗的74例头面部动静脉畸形患者的病例资料,男41例,女33例,年龄(29.1±10.6)岁。病灶位于耳部25例次,面颊部20例次,唇部18例次。根据病情分别采用无水乙醇介入栓塞治疗、单纯手术治疗、手术+无水乙醇介入栓塞综合治疗。结果本组74例,治愈50例,改善24例,治愈率67.6%。无水乙醇介入栓塞治疗42例,治愈率64.3%(27/42);单纯手术治疗15例,治愈率80.0%(12/15),无水乙醇介入栓塞+手术综合治疗17例,治愈率64.7%(11/17),3种方法治愈率比较差异无统计学意义(P>0.05)。随访时间(27.0±11.3)个月,1例复发。病灶累及单一解剖单位治愈率显著高于累及2个及以上解剖单位者(80.0%vs 48.3%,P<0.05)。结论采用多学科协作模式,根据病情、病灶解剖结构、病灶血管构筑特点、血流动力学特点合理选择手术、无水乙醇介入治疗,及两者的有机组合,可到达治疗效果和美学效果的最大化。

Objective To assess the treatment outcome of patients with head and facial arteriovenous malformation treated with absolute ethanol embolization alone,resection alone or combined ethanol embolization-resection.Methods Medical records of 74 patients[41 male and 33 female;age mean,(29.1±10.6)years])with head and facial arteriovenous malformation between January of 2014 and December of 2018 were reviewed retrospectively.The most common sites were ear(n=25),cheek(n=20),and lip(n=18).Based on the pattern of lesion location and extent,a classified treatment strategy including ethanol alone,surgical resection and combined ethanol embolization-resection was established to gain satisfied treatment efficacy.Results In total,cure was achieved in 50 patients(67.6%),and improvement was achieved in 24 patients.Ethanol embolization alone was performed in 42 patients[mean,(2.6±1.2)sessions].The dosage of ethanol used per single session ranged from was 1.5 to 24.0 ml.Cure was achieved in 27 patients(64.3%),and improvement was achieved in 15 patients(35.7%).Surgical resection alone was performed in 15 patients.Cure was achieved in 12 patients(80.0%),and improvement was achieved in 2 patients(20%).Local flaps were performed in 2 patients,expanded flaps in 11 patients,and free flaps in 2 patients.Combined ethanol embolization-resection was performed in 17 patients.Cure was achieved in 11 patients(64.7%),and improvement was achieved in 6 patients(35.3%).In total,cure was achieved in 50(67.6%)patients,improvement was achieved in 24(32.4%)patients,with a follow-up of 27.0±11.3 months.A total of 2 major complications occurred in 2 patients.One patient experienced recurrence.Lesions involving≥2 cervicofacial subunits had a lower cure rare compared with localized lesions(P<0.05).Treatment outcomes were not significantly related to the treatment modalities(P>0.05).Conclusions Surgical resection and ethanol embolization,alone or combination,should be integrated in a regimen to treat head and facial arteriovenous malformation for gaining both satisfied treatment efficacy and optimal cosmetic outcome.