颌骨高流速血管畸形的诊断和治疗

目的总结颌骨高流速血管畸形的诊断和栓塞治疗经验。方法1996年3月至2004年11月，具有完整影像资料的颌骨高流速血管畸形患者37例(上颌骨6例，下颌骨31例)，其中21例单纯行介入栓塞治疗，16例行手术治疗。采用的栓塞材料主要为附凝血棉纤毛的弹簧圈、二氰基丙烯酸对丁酯(NBCA)。手术方式分别采用颌骨的部分切除和保留下颌骨下缘的病变搔刮术。结果颌骨高流速血管畸形在X线平片上呈现多种表现，如囊状、骨小梁粗糙及“皂泡样”改变，多伴下颌神经管的扩张；在CT上表现为溶骨性改变，呈不同形式即单囊状和多囊状骨吸收。MRI可见颌骨体或升支部异常信号影，T1WI和T2WI均表现为低信号，其间可见流空信号影。血管造影可见颌骨内的异常血管团(又称“静脉池”)。上颌骨高流速血管畸形均呈动静脉畸形的血管构筑，下颌骨高流速血管畸形中的26例呈动静脉畸形的血管构筑，5例呈动脉畸形。在17例经动、静脉双路栓塞治疗的动静脉畸形和4例行动脉栓塞的颌骨动脉畸形中，16例急性出血得到了快速、有效控制，5例慢性渗血者栓塞治疗后症状消失，1例不全栓塞后再出血行手术切除。介入栓塞治疗后分别随访4～59个月，均未发现有口腔内渗血或出血。在随访的X线片上，病灶区可见新骨形成。结论颌骨高流速血管畸形无明确的X线平片特征，MRI和数字化血管造影(DSA)对其有特异性诊断意义。对动静脉畸形应行动、静脉的双路栓塞治疗，对动脉畸形应行供血动脉的超选择NBCA栓塞。

Diagnosis and treatment of high-flow vascular malformation of the jaws

Objective To report our experience on diagnosis and treatment of the high-flow vascular malformation of the jaws. Methods Thirty-seven cases of high-flow vascular malformation of the jaws (6 cases in maxilla and 31 in mandible) were comprised this study . Twenty-one patients were embolized with coils and N-buty1-2-cyanoacrylate, and 16 cases underwent surgery. The embolization was carried out with both arterial and venous route. Results Different signs of the lesions were demonstrated on X-ray plain film, such as locular,rough of bone trabecula and soap bubble-like changes ,frequently accompanied by dilatation of the mandibular nerve canal.CT scan showed unilocular and multilocular radiolucency. T_1WI and T_2WI on MRI exhibited low signal, and varix was found on DSA. The high-flow vascular malformation of the jaws classified into two groups: arterial malformation and arteriovenous malformation according to CT and DSA. The acute bleeding of 16 cases was effectively controlled by embolization. The chronic bleeding in the other 5 cases stopped after the 4-59 months and new bone formation was found in the follow-up radiography. Conclusions The characteristic signs were not unique on X-ray plain film, and MRI and DSA had diagnostic value. Arteriovenous malforination of the jaws should be embolized by direct puncture in conjunction with endovascular therapy, and arterial malformation be superselectively embolized with NBCA.