生物胶联合OK-432和平阳霉素治疗面颈部巨大静脉畸形

目的：评价生物胶联合OK-432和平阳霉素治疗面颈部巨大静脉畸形的临床疗效。方法：26例面颈部巨大静脉畸形患者,男11例,女15例;年龄4～23岁,平均年龄11.8岁。通过注射生物胶联合OK-432和平阳霉素进行治疗。所有病例均只接受1次治疗。结果：除术区2～3周肿胀外,均无严重并发症出现。随诊6～12个月（平均8.4个月）,19例治愈,5例显效,2例有效,无无效病例。结论：生物胶联合OK-432和平阳霉素经皮硬化术治疗面颈部巨大静脉畸形,效果良好,并且简单、安全和可靠。     

两种硬化治疗方法对面颈部巨大静脉畸形的疗效比较

目的比较生物胶联合OK-432和平阳霉素与区室化联合OK-432和平阳霉素两种硬化治疗方法对面颈部巨大静脉畸形的临床疗效。方法选择63例面颈部巨大静脉畸形患者,随机分为A、B两组,A组30例,B组33例。A组以生物胶联合OK-432和平阳霉素经皮共同注射;B组对病灶行区室化后,经皮注射OK-432和平阳霉素。两组均经气管插管全麻下进行,相隔1个月注射1次,连续注射1～5次。比较2组的疗效和并发症。结果随诊6～12个月,平均8.2个月。A组平均治疗时间1.5个月,平均治疗次数2.5次,20例治愈,6例显效,2例有效,2例部分有效,没有无效病例;治愈率为66.67%,总有效率为100%。B组平均治疗时间3.5个月,平均治疗次数4.3次,13例治愈,9例显效,9例有效,2例部分有效,没有无效病例,治愈率为33.33%,总有效率为100%。A、B两组治愈率差异有统计学意义(χ2=21.01,P<0.01);A、B两组患者均有局部肿胀,无严重并发症出现,差异无统计学意义(χ2=1.56,P>0.05)。结论生物胶联合OK-432和平阳霉素经皮硬化术治疗面颈部巨大静脉畸形疗程短、疗效良好、安全、可靠。     

纤维蛋白胶联合OK-432和博来霉素经皮硬化治疗头颈部大囊型淋巴管畸形

目的:评估纤维蛋白胶联合OK-432和博来霉素治疗头颈部大囊型淋巴管畸形的临床效果。方法 :回顾分析15例经皮硬化治疗巨大淋巴管畸形患者,男6例、女9例,年龄13个月～14岁(平均6.1岁)。治疗区域包括颈部(6例)、腮腺区和咽旁(4例)、口底(2例)、面颊部(2例)和眶区(1例)。病变大小4 cm×5 cm～12 cm×16 cm(平均7.7cm×9.5 cm)。全麻下注射纤维蛋白胶和OK-432、博来霉素混合物。术前、术后采用CT扫描,并由3名口腔颌面外科医师组成的小组评估其治疗效果。结果:术后3～4周面部肿胀,无其他严重并发症。随访8～16个月(平均11.5个月),8处病变完全治愈,5处大部分治愈,2处部分治愈。结论:纤维蛋白胶联合OK-432和博来霉素经皮硬化治疗头颈部大囊型淋巴管畸形是一种安全、可靠的治疗手段。     

平阳霉素联合生物胶硬化治疗头颈部静脉畸形

目的探讨平阳霉素联合牛物胶硬化治疗头颈部静脉畸形的临床疗效。方法用平阳霉素（2—8mg）和生物胶（4～20mL）对24例头颈部静脉畸形病灶进行经皮或经黏膜注射,每2周注射1次,连续注射2～5次。结果所有患者硬化治疗后均出现明显的局部肿胀和轻微疼痛,部分患者发热,无严重并发症发生,经4～13个月随诊,7例治愈,ll例显效,5例有效,1例无效。全部患者肝肾功能正常,x线检查肺部尤异常。结论平阳霉素联合生物胶硬化治疗头颈部静脉畸形方法简单,副作用小,治疗周期短,疗效可靠。     

面颈部巨大静脉畸形区室化硬化治疗的疗效观察

目的：评价区室化硬化治疗面颈部巨大静脉畸形的临床疗效。方法：对16例巨大面颈部静脉畸形患者（男12例，女4例，年龄6～22岁，平均14．9岁）的病损，用丝线缝扎间隔成多个小区室，再用OK-4320．1mg（儿童）或0．2mg（成人）和平阳霉素4mg（儿童）或8mg（成人）对每一区室进行多次经皮注射。每2周注射1次，连续注射3～5次。结果：全部病例术后均出现明显的局部肿胀和轻微疼痛，无严重并发症发生。1例出现暂时性面瘫，2周内自行恢复。经3～14个月（平均7．7个月）复查，4例病变完全消退，6例病变大部分消退，5例病变部分消退，1例病变少部分消退。全部患者肝肾功能正常，X线检查肺部无异常。结论：区室化OK-432和平阳霉素硬化治疗面颈部巨大静脉畸形是一种简单、安全和有效的治疗手段。     

口腔颌面部动静脉畸形栓塞后应用环扎及电化学联合平阳霉素治疗的疗效评价

目的：评价环扎、电化学疗法联合平阳霉素注射治疗口腔颌面部软组织动静脉畸形的临床疗效。方法 ：2008年1月—2012年12月间采用环扎、电化学疗法联合平阳霉素注射治疗26例口腔颌面部软组织动静脉畸形,回顾分析其治疗效果及不良反应发生情况。根据疗效评价标准,将治疗结果分为治愈、好转、无效。结果：全组随访8个月-2 a,26例患者病变均不同程度缩小,有效率100%,临床治愈率77%（20/26）。术后不良反应主要是肿胀、疼痛、发热等,未见严重不良反应。结论：环扎、电化学疗法联合平阳霉素注射治疗口腔颌面部软组织动静脉畸形创伤小、无瘢痕,可重复治疗,外形和功能恢复良好,是一种有效的治疗方法。     

用~(111)铟标记的博莱霉素诊断颌面部鳞癌

放射性核素~(99)m锝磷酸盐骨扫描主要用于显示骨内的成骨活动,但不能显示软组织内的病变。1967年以来,博莱霉素治疗颌面部鳞状细胞癌获得成功。博莱霉素对恶性鳞状细胞的亲和力高,本研究用~(111)铟标记的博莱霉素作颌面部扫描,探讨其在肿瘤术前诊断和发现肿瘤复发及淋巴结受累的价值。资料和方法46例患者中,男5例,女41例,年龄47～75岁,均经临床和活检证实为鳞癌。其中位于下颌部33例,上颌部4例,扁桃体5例,下咽部1例,前额部1例,颊部2例。术前肿瘤直径均大于0.5cm,最大者9cm。静脉注射~(111)铟博莱霉素0.5毫居里后第1、     

OK-432病变内注射后舌下腺囊肿囊液中IL-1α、TNF-β的变化及意义

目的：检测OK-432注射前后舌下腺囊肿囊液中IL—1α和TNF—β的含量变化，探讨OK-432治疗的机理。方法：11例舌下腺囊肿患者（单纯型5例，下陷型6例）接受病变内注射OK-432治疗，观察临床疗效，治疗前后抽取囊液分析IL—1α和TNF-β的含量。结果：11例中7例经过一次硬化治疗后囊肿完全消失，2例经过二次治疗后囊肿完全消失，治愈率达82％。患者治疗前后囊液中IL—1α的含量分别为21pg/ml和765pg／ml，TNF—β的含量分别为39pg／ml和1146pg／ml，有显著性差异。结论：病变内注射OK-432治疗舌下腺囊肿效果好，其机理可能与细胞因子的分泌有关。     

三维CT血管造影在颌面部动静脉畸形诊断中的应用

目的探讨三维CT血管造影（3D—CTA）图像对口腔颌面部动静脉畸形（AVMs）的诊断价值。方法分析8例口腔颌面部AVMs患者的临床资料,观察3D—CTA对病灶形态、大小、范围、边界、骨质破坏、供血动脉和引流静脉的显示情况。结果8例AVMs患者5例发生在颌面部软组织．3例发生在下颌骨：3D—CTA均显示病灶为紊乱的血管团和血窦,边界清楚;一、二级供血动脉和引流静脉增粗、突起、扭曲;4例可见骨质吸收破坏。结论3D—CTA能准确有效地显示动静脉脉畸形的形态特点和供血动脉及引流静脉．能提供较多的诊断信息。     

4例儿童期颌骨动静脉畸形血管复通的再治疗

目的总结治疗儿童期上、下颌骨动静脉畸形治疗后血管复通的临床经验。方法回顾分析4例儿童期颌骨动静脉畸形（arteriovenous malformations, AVMs）患者的临床资料。所有患者均接受过至少26个月以上的颌骨AVM的多学科综合治疗,包括超选择性动脉内栓塞、颌骨骨腔内骨蜡填塞联合拔牙术,并应用计算机体层血管造影术（CTA）及数字减影血管造影术（DSA）证实AVM治疗后存在血管复通。对出现血管复通的患者,再次施以超选择性动脉内栓塞联合颌骨骨腔内骨蜡填塞及拔牙（如有必要）的综合治疗。结果4例患者随访5~14个月,平均9.5个月,均预后良好,无治疗后搏动感存在或出血。结论儿童期颌骨AVM综合治疗后,极少病例出现治疗后血管复通,再次应用超选择性动脉内栓塞联合颌骨骨腔内骨蜡填塞以及拔牙等综合治疗效果良好,值得推广应用。     

Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the face and neck using fibrin glue with OK-432 and bleomycin

Picibanil (OK-432) and bleomycin have been used as alternative sclerosing agents for lymphatic malformations. This study evaluated the clinical curative effect of sclerotherapy using fibrin glue combined with OK-432 and bleomycin for the treatment of macrocystic lymphatic malformations of the face and neck. Fifteen paediatric patients (6 males; 9 females, aged 13 months to 14 years) who had received percutaneous sclerotherapy for massive macrocystic lymphatic malformations of the face and neck were retrospectively reviewed. Affected regions included the neck, parotid region and parapharynx, mouth floor, face and cheek, and orbital regions. All patients showed preoperative symptoms of space-occupying lesions between 4 cm × 5 cm and 12 cm × 16 cm in size. Fibrin glue with OK-432 and bleomycin was injected under general anaesthesia. All patients received preoperative and follow-up CT scans. Outcomes were assessed by three surgeons. All patients exhibited mid-facial swelling for 3-4 weeks after surgery, but no major complications. Follow-up periods ranged from 8 to 16 months. Eight lesions were completely involuted, five were mostly involuted, and two were partially involuted. Percutaneous sclerotherapy using fibrin glue with OK-432 and bleomycin provided a simple, safe, and reliable alternative treatment for massive macrocystic lymphatic malformations of the face and neck.     

Percutaneous sclerotherapy of sialoceles after parotidectomy with fibrin glue,OK-432, and bleomycin

We evaluated the curative effect of fibrin glue combined with OK-432 (streptococcal pyrogenic exotoxin A, Picibanil™) and bleomycin on 9 patients with sialoceles after parotidectomy. The primary lesions included pleomorphic adenomas in 6 cases and Warthin's tumours in 3 cases. After a sialocele had been diagnosed each patient had repeated aspirations and pressure dressings for 3–4 weeks, but these treatments failed. The patients were then treated with percutaneous sclerotherapy with the injection of fibrin glue 8–10 ml combined with OK-432 5 mg and bleomycin 15 mg. All the sialoceles disappeared completely after a single procedure in 2–3 weeks. The patients have been followed up for more than 6 months with no evidence of recurrent sialocele or injury to the facial nerve related to sclerotherapy. This simple, safe technique can be successfully used to treat sialoceles after parotidectomy.     

Comprehensive treatment of arteriovenous malformations in the oral and maxillofacial region.

PURPOSE: Arteriovenous malformations (AVMs) in the oral and maxillofacial region are rare but potentially life-threatening vascular lesions. We report our experience in treating these lesions in the oral and maxillofacial region. PATIENTS AND METHODS: Superselective intra-arterial embolization (SIAE), sclerotherapy, bone wax packing of bone cavity and curettage, radiotherapy, and surgical resection were used alone or in combination in 28 patients with AVMs in the oral and maxillofacial region. Among them there are 13 cases involving the soft tissue, 11 cases involving bone, and 4 cases involving both the soft tissue and bone. RESULTS: Follow-up ranged from 3 to 60 months (median, 22 months) after comprehensive treatment. The rates of improvement and cure were 89.3% and 60.7%, respectively. Sclerotherapy in 6 cases of AVMs was ineffective. The rates of improvement and cure in AVMs involving soft tissue treated by surgical resection were 23.1% and 84.6%, respectively. The rates of cure for AVMs involving the jaws treated by SIAE, bone wax packing, curettage, and partial bone resection alone or in combination was 100%. CONCLUSION: Three cases of AVMs involving both soft tissue and bone treated with SIAE and radiotherapy as well as surgical resection were cured. SIAE was an adjunctive treatment for the AVMs of soft tissue and jaws and for controlling bleeding. Surgical resection was an important treatment modality for AVMs. Bone wax packing of bone cavity and curettage was a simple, safe, and effective method for the treatment of AVMs of the jaws. Radiotherapy and sclerotherapy may not be effective methods for AVMs involving the soft tissue.     

射频消融技术联合DSA引导下无水乙醇介入治疗口腔颌面部难治性动静脉畸形的疗效观察

目的 探讨射频消融技术联合数字减影血管造影（digital subtraction angiography,DSA）引导下无水乙醇介入治疗难治性口腔颌面部动静脉畸形的可行性,评价其临床疗效及安全性。方法 2014年3月—2016年4月,应用射频消融技术联合DSA引导下无水乙醇介入栓塞治疗7例口腔颌面部动静脉畸形患者（男4例,女3例）,密切随访,根据患者的临床症状、不良反应、并发症以及影像学资料的变化进行疗效观察及评价。结果 6例有效,1例无效,治疗有效率为85.7%。未观察到严重并发症发生。结论 射频消融技术联合DSA下无水乙醇介入栓塞治疗难治性口腔颌面部动静脉畸形的近期疗效及安全性良好,可能成为其重要的治疗方式。     

Management of massive venous malformations by percutaneous injection of bleomycin combined with fibrin glue in the head and neck

PurposeThe aim of this study was to evaluate the effectiveness of percutaneous injection of bleomycin combined with fibrin glue in treating massive venous malformations (MVMs) in the head and neck region.Materials and methodsA retrospective case series analysis of 22 patients who underwent percutaneous sclerotherapy between June 2015 and December 2018 was performed. All the patients were examined by comparing the size of the venous malformations (VMs) and their responses to treatment including complications in the follow-up.ResultsThe follow-up period ranged from 6 to 24 months. Ten patients (10/22) were completely cured and 10 patients (10/22) exhibited excellent size reduction of their VMs. Two patients (2/22) exhibited reasonable size reduction and were recommended to undergo a second sclerotherapy procedure. However, both patients were satisfied with the outcomes and refused subsequent treatment. Neither systemic nor local complications occurred in this study. All the patients were satisfied with their significant size reductions and symptom improvements without recurrences during follow-up.ConclusionPercutaneous injection of bleomycin combined with fibrin glue is a promising treatment option that yielded excellent size reduction with a low risk of complications on MVMs in the head and neck region.     

纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部动静脉畸形效果观察

目的: 观察和评价纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部动静脉畸形的临床效果。方法: 2012年12月—2016年12月,选择22例面颈部动静脉畸形病例,应用纤维蛋白胶复合平阳霉素栓塞硬化技术进行治疗。其中15例患者给予单纯经皮穿刺直接注射治疗,2例患者除原发灶区经皮穿刺直接注射外,同时行面动脉注射治疗,6例患者栓塞硬化治疗完成后,手术切除病变区增厚的纤维结缔组织及残余病变。治疗后观察患者生命体征,体格检查、彩色多普勒超声及CT、CTA评价治疗效果。随访时间6~36个月（平均18个月）。结果: 22例患者中,男17例,女5例;年龄19~74岁（平均28岁）。18例（81.8%）患者病变消退率大于90%,4例（18.2%）病变消退率大于50%。治疗过程中,部分患者出现皮肤发白或青紫色改变,提示组织缺血或回流受阻。1例患者额部出现皮肤浅层坏死,局部形成薄痂;2例患者出现唇黏膜浅溃疡,均自行愈合。随访发现,3例患者病变继续生长。结论: 纤维蛋白胶复合平阳霉素栓塞硬化技术用于治疗面颈部动静脉畸形安全、有效,尤其对局限性扩张型动静脉畸形效果较好。     

纤维蛋白胶/博来霉素栓塞硬化治疗面颈部血管畸形彩色多普勒超声研究

目的:通过多普勒超声探索纤维蛋白胶复合搏来霉素(FG/BLM)栓塞硬化面颈部血管畸形的作用机制.方法:纳入面颈部静脉畸形(VM)、动静脉畸形(AVM)患者各10例.在超声引导下进行FG/BLM栓塞硬化治疗,彩色多普勒超声记录FG/BLM注射到病变瘤(管)腔后的实时二维声像图及彩色血流变化,判断药物注射后的流向及范围.结果:二维声像图可见FG/BLM注射到VM瘤腔后即刻注射物瞬间呈团状或片状强回声,随后漂浮于畸形静脉腔内并弥散到瘤腔各处.后期可见病变区被大量絮状及网状低回声伴斑片状强回声充填,瘤腔体积显著膨胀,彩色血流显示病变区内血流信号明显减少.注射到AVM管腔后注射物瞬间呈团状或片状强回声,随后可见雪花状强回声大部分随血流快速充填或散落到注射血管腔的远端,后期病变区周边被大量蜂窝状中等回声及斑片状强回声充填,病变区彩色血流显著减少.结论:FG/BLM注射到VM瘤腔后对回流静脉有栓塞、阻断作用,对注射到瘤腔的硬化剂有贮存作用.FG/BLM注射不仅能够栓塞硬化局限性AVM的扩张血管,还能够栓塞其毛细血管网.