体表软组织动静脉畸形的手术治疗:单中心回顾性研究

Surgical management of soft tissue arteriovenous malformations:A retrospective study in one center

目的探讨体表软组织动静脉畸形(Arteriovascular malformations,AVM)手术治疗策略。方法回顾性分析2007年1月至2022年12月期间在我科进行手术治疗的43例体表软组织AVM病例的资料,其中男23例,女20例,年龄8~62岁,平均27.3岁。病灶位于头颈部29例,躯干部5例,上肢4例,下肢5例。对病灶进行Schobinger临床分期和Yakes血管构筑学分型,分析手术治疗方法和结果,总结手术治疗策略。结果本组43例患者,根据Schobinger临床分期,本组病例Ⅰ期8例、Ⅱ期21例、Ⅲ期13例、Ⅳ期1例。根据Yakes血管构筑分型,本组Ⅰ型5例、Ⅱ型13例、Ⅲ型7例、Ⅳ型17例,1例缺少血管造影结果未分型。手术方法包括直接手术切除(29例)、介入栓塞后手术切除(5例)、应用扩张器分期手术切除(6例)和截肢/截趾/截指(3例)。创面修复方法中,14例直接关闭创面,15例采用皮片修复,6例采用扩张皮瓣修复,8例采用局部皮瓣修复。所有切口一期愈合,皮片和皮瓣成活好。随访6~112个月(平均33.7个月),治愈37例,改善6例,治愈率84%。结论根据动静脉畸形的部位、解剖关系、临床分期和血管构筑分型,联合介入栓塞和扩张器治疗等方法,进行个性化手术治疗,能获得比较满意的近期和远期效果。

Objective To evaluate the surgical management of patients with soft tissue arteriovenous malformations.Methods Data of 43 AVM patients who underwent surgical treatment in our department from January 2007 to December 2022 were retrospectively analyzed,including 23 males and 20 females,aged 8-62 years,with an average age of 27.3 years.The lesion sites included head and neck(n=29),trunk(n=5),upper limbs(n=4)and lower limbs(n=5).The situation of these patients was evaluated according to the Schobinger staging system and Yakes classification.The strategy of surgical management was summarized based on the methods and outcomes of the above cases.Results A total of 43 patients were included in the study.According to the Schobinger staging system,there were 8 stageⅠ,21 stageⅡ,13 stageⅢand 1 stageⅣpatients.Based on the Yakes classification,the lesions included 5 Yakes typeⅠ,13 typeⅡ,7 typeⅢ,and 17 typeⅣ.One of the patients could not be classified with Yakes classification due to lack of vascular imaging results.Simple surgical resection was performed in 29 patients,combined preoperative superselective embolization with surgical resection was performed in 5 patients,two-stage surgical resection with application of tissue expanders was performed in 6 patients,amputation was performed in 3 patients.As for wound repair,primary linear closure was performed in 14 patients,skin grafting in 15 patients,expanded flaps in 6 patients,and local flaps in 8 patients.The incisions healed primarily.Skin grafts and flaps survived well.During the follow-up of 6-112 months(33.7 months on average),37 patients were cured(84%)and 6 improved.Conclusion Based on the site,anatomy,clinical staging and Yakes classification,combined with interventional embolization and expanders,personalized surgical treatment can obtain satisfactory short-term and long-term results.