合并呼吸道梗阻的血管瘤和脉管畸形32例治疗分析

目的：总结合并呼吸道梗阻的血管瘤和脉管畸形的临床特点和治疗经验。方法：1985年6月～2003年6月间．收治32例合并不同程度的呼吸道梗阻和呼吸困难的血管瘤和脉管畸形病例，男20例，女12例，年龄2个月～46岁。平均年龄9．31岁。其中血管瘤3例，静脉畸形12例，淋巴管畸形17例。病变原发于咽喉部4例，面颈部病变压迫或侵犯咽喉26例，上纵隔病变压迫气管2例。合并Ⅰ度、Ⅱ度、Ⅲ度呼吸困难分别为22例、7例、3例。采用口服糖皮质激素治疗3例．平阳霉素等硬化剂病变内注射治疗14例，手术治疗3例，手术 硬化剂病变内注射治疗12例。32例中，紧急气管切开4例，预防性气管切开11例。结果：3例血管瘤、16例淋巴管畸形和10例静脉畸形治愈；1例淋巴管畸形和2例静脉畸形好转；无效病例0例。结论：对合并呼吸道梗阻的血管瘤和压迫咽喉或气管的淋巴管畸形，分别采用激素疗法和单纯平阳霉素病变内注射治疗，治愈率高，一般不需气管切开；原发于咽喉部的局限性静脉畸形和淋巴管畸形手术容易治愈：侵犯咽喉部的静脉畸形和淋巴管畸形多合并面颈部广泛性病变，需采取手术 硬化剂注射 气管切开的综合治疗．方能治愈或控制病变发展。     

铜针留置术加硬化剂治疗颌面部巨大静脉畸形

目的：观察铜针留置通电加硬化剂注射治疗颌面部巨大静脉畸形的临床效果。方法：对5例颌面部巨大静脉畸形，首先采用铜针留置通电，降低血液流速，再辅以硬化剂注射，根据Achauer等的分级标准评价治疗效果。结果：5例患者中，2例为Ⅱ级，治疗后病变缩小26％-50％；3例为Ⅲ级，治疗后病变缩小51％-75％。结论：铜针留置加硬化剂治疗颌面部巨大静脉畸形效果显著，该治疗方法简单、安全、有效。     

口腔颌面-头颈部静脉畸形诊治指南

静脉畸形是常见的良性病变,约40%发生于头颈部,严重影响患者的容貌和功能,甚至可并发大出血或呼吸道梗阻而危及生命。目前采用的治疗方法有手术、激光、硬化剂注射等。小而浅表的静脉畸形治疗较为简单,效果良好;而累及多个解剖分区的深部、广泛病变治疗困难,是临床上面临的一大挑战。对于复杂病例,单一治疗方法的效果欠佳,需根据患者的病情和医疗机构的技术条件,制定个体化治疗方案,采用综合序列治疗,以期获得最佳疗效。本文参考国内外相关文献和诊治经验,制定口腔颌面-头颈部静脉畸形诊治指南,希望对临床规范治疗起到指导作用。本指南将及时予以更新,以反映和纳入最新研究成果,为广大患者提供最好的治疗方案。     

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静脉畸形是最常见的低流速脉管畸形,大多发生于头颈部,不仅影响患者面容,引发疼痛、溃疡、出血,还可压迫或侵及邻近组织器官,从而影响语言、吞咽及呼吸功能,甚至危及生命。静脉畸形的治疗方法包括手术、激光、硬化剂注射、电化学治疗等,但对范围广泛的巨大病变,则需多学科综合序列治疗方能达理想的治疗效果。本文旨在结合笔者的临床经验及国内外文献,对头颈部静脉畸形的综合序列治疗进行评述,强调无水乙醇硬化治疗在其中的重要性和必要性。由于无水乙醇注射可能引起严重并发症,建议此项操作由有经验的医师进行。     

面颈部微静脉畸形的治疗

微静脉畸形又名鲜红斑痣、葡萄酒色斑,多发生于头颈部。以往治疗微静脉畸形的方法有冷冻、放射性核素敷贴、激光、硬化剂注射、化学剥脱等,疗效均不理想。近年来,随着医学激光技术的发展和光动力疗法的应用,微静脉畸形的治疗有了很大进展,但仍很不成熟。作者就目前临床常用的一些治疗方法及其疗效进行文献复习和讨论。     

唇部静脉畸形的治疗

目的 :报道 81例唇部静脉畸形的治疗经验。方法 :81例病变分别采用硬化剂注射、Nd :YAG激光治疗、手术切除以及上述方法的联合治疗。结果 :5 8例完全治愈 ,19例基本治愈 ,3例明显改善。结论 :绝大多数唇部静脉畸形可通过非手术方法治愈。     

泡沫硬化剂治疗脉管畸形的研究进展

脉管畸形是先天性发育异常,好发生于口腔颌面部,可能与调节正常血管树形成的传导通路异常有关。按照其组织学特点、临床特征及影像学表现又可分为微静脉、淋巴管、静脉、动静脉及混合畸形。由于脉管畸形临床表现及组织学构成具有复杂多样性,临床治疗效果不一,多数治疗方法有局限性。目前,对大面积、涉及多个解剖区的脉管畸形的治疗,尚缺乏简单、安全而有效的方法。病变内注射硬化剂是常用的治疗方法之一,可单独使用或结合手术综合治疗。     

局部穿刺DSA引导下硬化剂序贯介入治疗口腔颌面部静脉畸形

目的　探讨理想和安全的治疗口腔颌面部静脉畸形的方法。方法　在瘤体穿刺造影指导下,对43例口腔颌面部静脉畸形行硬化剂序贯介入治疗。结果　随访7个月~3年,病变完全消退者7例;28例消退率≥50%;5例消退率25%~50%;3例病变消退率＜25%。未发生肺动脉栓塞等严重并发症,面形及口腔功能良好。结论　对口腔颌面部静脉畸形予无水乙醇、平阳霉素乳剂序贯硬化治疗,安全有效。     

淋巴管畸形的硬化治疗

淋巴管畸形是一种常见的脉管畸形.硬化治疗是一种常用的治疗方法,临床将其作为一线治疗均获得较满意的疗效且无明显并发症.目前应用的硬化剂种类繁多,但没有一种能适应于所有病变.由于病变类型不同及使用的硬化剂不同,回顾性研究的结果也不一致.较多的临床研究表明,大囊型淋巴管畸形硬化治疗的疗效优于微囊型,对于大囊型病变或以大囊成分...     

口腔颌面部静脉畸形诊治：经验与进展

静脉畸形是临床上最常见的先天性血管畸形,可发生于全身各个部位。其病变位置及范围的多样性,使得静脉畸形的诊断和治疗富有挑战性。目前,口腔颌面部静脉畸形的治疗方法主要包括硬化治疗、手术治疗、激光治疗等。本文通过对近几年文献的回顾,结合作者经验,对静脉畸形诊断和治疗的相关进展进行了总结。     

Current concepts in diagnosis and treatment of venous malformations

IntroductionVenous malformations are the most common type of vascular malformation, usually detected at birth or during puberty. By occurring during human growth or through localized trauma, pain, functional impairment and aesthetic disfigurement is often observed.Ultrasonography, Doppler flow Imaging, and Magnetic Resonance Imaging are the most informative techniques which reveal the extent of tissue involvement and differentiate between high and low flow anomalies. Therapeutic options for treatment of venous malformations are sclerotherapy with alcohol, ethoxysclerol and bleomycin, laser therapy (Nd:YAG), surgery and combined therapeutic modalities. The aim of percutaneous sclerotherapy is the successive reduction of the volume of the lesion by aseptic inflammation.Patients and methodsThis is a review of 51 patients with venous malformation treated by the Interdisciplinary Center for Vascular Anomalies at the University Hospital Tübingen, (Germany), from July, 2002 until January, 2007. The mean age of first consultation in our outpatient department was 26.4 years (median).12 patients were treated by sclerotherapy with highly concentrated alcohol, 9 by surgery, and 7 by laser therapy. In some cases we combined different treatments. 9 patients had only sclerotherapy, while 3 had a combination of pre-operative sclerotherapy and surgery.ResultsWe obtained positive results in patients treated with sclerotherapy and combined sclerotherapy and surgery.ConclusionSclerotherapy is safe (under fluoroscopic control), efficient, and can be repeated multiple times. Therefore, it should be considered as first-line treatment in venous malformations. A combination of a sclerotherapy with surgery is also useful in many cases.     

Intraosseous mandibular venous malformation

ABSTRACT: Intraosseous venous malformations are rare benign lesions that account for approximately 0.5% to 1% of all osseous tumors. Involvement of the facial skeleton is rather uncommon, with the mandible and maxilla most frequently involved. In the current study, we report a case of an intraosseous venous malformation in a 52-year-old male patient with a history of mandibular keratocystic odontogenic tumor. The patient presented with an asymptomatic bony lesion in the mandible. Treatment involved surgical excision. Histopathologic examination of the excised specimen revealed an intraosseous venous malformation. Twelve months postoperatively, there was no evidence of recurrence.     

Removal of a nasal bone intraosseous venous malformation and primary reconstruction of the surgical defect using open rhinoplasty

Primary intraosseous venous malformations are rare benign tumors that account for approximately 1% of all primary osseous tumors. They are rarely found in the midface. The authors report a case of an intraosseous venous malformation in a 28-year-old woman who presented with a bony lesion in the nasal bone. Treatment involved surgical excision via open rhinoplasty. Histopathology indicated an intraosseous venous malformation. 16 months postoperatively, there was no evidence of recurrence, the functional and cosmetic results were good, and the patient was satisfied with the treatment outcome.     

经皮穿刺DSA引导下无水乙醇硬化治疗头颈部静脉畸形

目的：探讨DSA引导下无水乙醇硬化治疗头颈部静脉畸形的效果。方法：对2006年3月-2008年4月间应用DSA引导下无水乙醇硬化治疗的53例头颈部静脉畸形患者进行回顾分析,采用影像学及问卷调查的方法评价治疗效果,并对治疗并发症进行分析。结果：所有患者均对治疗效果满意。术后MRI显示,12例病变完全消退,32例消退率≥50%,7例消退率25%～50%,2例消退率〈25%。并发症包括暂时性面神经麻痹、皮肤黏膜溃疡,除1例发生永久性面瘫外,其余并发症经处理均消失。无肺动脉痉挛及肺动脉栓塞严重并发症。结论：DSA引导下无水乙醇硬化治疗头颈部静脉畸形是一种安全有效的方法。     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.