术前栓塞结合手术切除瘤巢治疗体表动静脉畸形的疗效观察

Efficacy of preoperative embolization combined with surgical resection in the treatment of high-flow arteriovenous malformations

目的探讨术前介入栓塞技术结合手术切除瘤巢在体表动静脉畸形(arteriovenous malformation,AVM)治疗中的应用方法及其临床效果。方法回顾性分析自2016年3月至2021年8月,北京大学第三医院成形外科对16例经超声、CTA、MR、DSA等检查后确诊为AVM的患者,以辅助手术切除瘤巢为目的进行介入栓塞治疗。术前48 h内按照手术切除瘤巢方式设计术前栓塞方案,栓塞后病变区域行AVM瘤巢切除术。结果16例患者均顺利完整切除AVM瘤巢。无大出血、失血性休克等严重并发症发生。术后获随访1~5年,均无复发。结论当高流量AVM具备手术切除可能,而大出血是手术最大障碍时,术前以降低血流速度为目的介入栓塞,血流降速后通常在48 h内手术切除瘤巢,不但可以提高手术安全性,使术者较从容完成整个手术过程,避免严重并发症出现,还能够达到根治AVM,减少复发的目的。

Objective To explore the application and clinical effect of preoperative interventional embolization combined with surgical resection of nidus in the treatment of high flow extracranial arteriovenous malformations(AVW).Methods From March 2016 to August 2021,patients at the Department of Plastic Surgery,of Peking University Third Hospital who were diagnosed as high flow arteriovenous malformation by ultrasound,CTA,MR,DSA and other examinations were treated with interventional embolization for the purpose of removing nidus by surgery.Results A total of 16 patients underwent preoperative embolization design and were embolized within 48 hours before the surgery.All the 16 patients were successfully resected the arteriovenous malformation lesions completely,and no severe complications such as massive bleeding and hemorrhagic shock occurred.There was no recurrence in 1 to 5 years'follow-up.Conclusion Massive bleeding is the biggest obstacle in high-flow arteriovenous malformation surgery.If surgical resection is possible,interventional embolization should be performed before the surgery to reduce blood flow velocity.Surgical excision of the lesion usually within 48 hours after the blood flow rate is reduced.This solution can not only help us improve the safety of the operation,enable the operator to easily complete the entire operation process and avoid serious complications,but also can cure high-flow arteriovenous malformations and reduce recurrence.