口腔颌面部软组织动静脉畸形栓塞治疗与疗效分析

Application of embolization for arteriovenous malformations of the soft tissue in oral and maxillofacial region

目的 研究口腔颌面部软组织动静脉畸形 (ArteriovenousMalformation ,AVM )的血管构筑特征 ,探讨其栓塞治疗方法与疗效。方法 对 11例口腔颌面部软组织AVM行造影及栓塞治疗 ,其中 5例深部间隙AVM中 ,1例行单纯动脉栓塞 ,1例行单纯瘤腔栓塞 ,3例行动脉及瘤腔栓塞 ;6例浅表AVM中 ,5例行单纯动脉栓塞 ,1例行动脉及瘤腔栓塞。栓塞材料 1例采用PVA ,3例采用NBCA ,7例采用PVA及NBCA。结果 5例深部间隙AVM造影均显示畸形静脉团 ,其中 4例经瘤腔栓塞后随访 12～ 30个月无复发 ;1例经动脉栓塞后 18个月无复发。6例浅表AVM病变血管均较弥散 ,其中 4例在栓塞治疗 (共 8次 )后随访 6～ 15个月 ,病变得到控制 ;另 2例栓后手术 ,随访 6～ 12个月无复发。结论 颌面深部间隙AVM多含明显静脉池 ,应行动脉及瘤腔栓塞 ,部分病变有望得以根治 ;浅表AVM血管多较弥散 ,宜采用动脉栓塞 ,若皮肤受累可于栓后行病变切除及修复术。

Objective To evaluate angioarchitecture of arteriovenous malformations (AVM) of the soft tissue in oral and maxillofacial region and to investigate the approaches and efficacy of intravascular embolization.Methods Eleven cases with large soft tissue AVMs in oral and maxillofacial region,including five cases with deeply-seated and six cases with superficial lesions, underwent embolization.Of the eleven cases,six experienced intraarterial embolization,one experienced intranidus embolization,and four experienced intraarterial and intranidus embolization.The materials applied were PVA in one,histoacryl glue in three,PVA and histoacryl glue in seven cases.Results Five cases with deeply-seated AVMs showed large venous nidus on angiograms,four of them were well for 12～30 months after intranidus embolization;another was without recurrence for 18 months after intraarterial embolization. Of the six cases with superficial AVMs,four were well for 6～18 months after eight embolization procedures in all;the other two cases experienced resection after embolization and were without recurrence for six and twelve months respectively.Conclusion Treatment methods of soft tissue AVMs depend mainly on their angioarchtecture.The cases with deeply-seated AVMs often have obvious venous nidus and could be cured with intraarterial and direct percutaneous embolization;superficial AVMs are commonly diffused;therefore,embolization and resection are both necessary.