以栓塞硬化为主综合治疗眼睑海绵状血管瘤

目的探讨治疗眼睑海绵状血管瘤的有效方法.方法用栓塞硬化注射术,或结合手术切除部分硬化瘤体,或结合铜针留置术,治疗眼睑海绵状血管瘤.结果治疗患者17例,其中11例只进行栓塞硬化治疗,2例栓塞硬化后手术切除治疗,4例铜针留置后栓塞硬化治疗.所有患者治疗后眼睑瘤体缩小,未出现并发症.随访6个月至4年,治疗部位无复发,局部功能形态良好.结论以栓塞硬化为主综合治疗眼睑海绵状血管瘤,简便有效,创伤小,不易复发.     

以栓塞硬化为主综合治疗眼睑海绵状血管瘤

目的 探讨治疗眼睑海绵状血管瘤的有效方法。方法 用栓塞硬化注射术，或结合手术切除部分硬化瘤体，或结合铜针留置术。治疗眼睑海绵状血管瘤。结果 治疗患者17例，其中11例只进行栓塞硬化治疗，2例栓塞硬化后手术切除治疗，4例铜针留置后栓塞硬化治疗。所有患者治疗后眼睑瘤体缩小，未出现并发症。随访6个月至4年。治疗部位无复发，局部功能形态良好。结论以栓塞硬化为主综合治疗眼睑海绵状血管瘤，简便有效，创伤小，不易复发。     

体表不同类型血管瘤的综合治疗

目的 探讨治疗体表不同类型血管瘤的有效方法.方法 自2006年至2008年,共收治体表不同类型血管瘤40例.其中7例蔓状血管瘤患者行术前选择性动脉栓塞;12例弥漫型海绵状静脉畸形患者术中联合Nd:YAG激光照射;8例弥漫型海绵状静脉畸形患者行术前介入栓塞后联合手术切除治疗;6例弥漫型海绵状血管瘤患者行局部硬化剂注射联合手术切除治疗;7例混合性血管瘤行Nd:YAG激光照射联合手术切除治疗.结果 所有患者术后均随访1年以上,治愈20例,显效13例,有效4例,术后复发3例,总有效率为92.5%.其中行手术切除联合术前供瘤动脉栓塞治愈8例,显效5例,有效2例;术中联合Nd:YAG激光照射治愈11例,显效5例,有效1例,术后复发2例;行局部硬化剂注射联合手术治疗的弥漫型海绵状静脉畸形治愈1例,显效3例,有效1例,术后复发1例.结论 根据不同类型血管瘤,选择手术切除联合术前供瘤动脉栓塞、术中Nd:YAG激光照射或局部硬化剂注射的综合治疗方法,疗效满意.     

颌面部软组织肿物的介入栓塞与手术治疗

目的 探讨介入栓塞与手术治疗在颌面部软组织肿物诊断和治疗中的应用价值.方法 搜集2005年2月至2008年3月,采用介入栓塞与手术整复治疗的血管畸形、混合型血管瘤、神经纤维瘤等体表软组织肿物患者42例,分析其临床效果及并发症.结果 10例混合型血管瘤患者采用硬化治疗后,瘤体明显缩小、变硬;26例海绵状静脉畸形患者中,20例采用栓塞硬化治疗,6例采用栓塞硬化与手术相结合的方法进行治疗,有2例患者面部及咽后壁软组织肿物造影显示病变侵犯广泛,行栓塞硬化治疗2次,未行手术治疗;3例动静脉畸形及3例神经纤维瘤患者.采用栓塞硬化与手术相结合的方法进行治疗,治疗后瘤体萎缩变小,其中1例神经纤维瘤患者术后6个月再次手术修复.术后随访6～12个月,所有瘤体缩小或消失.结论 介入栓塞与手术综合治疗是诊断和治疗颌面部软组织肿物安全有效的方法.     

海绵状静脉畸形自发栓塞5例暨文献回顾

目的 总结海绵状静脉畸形自发栓塞的临床表现,并探讨其临床意义.方法 自2003年2月至2006年5月,收治海绵状静脉畸形自发栓塞的患者共5例.经采集病史,行彩色多普勒、DSA等检查后,均行瘤体切除术.术后将标本送病理检查.结果 术前5例患者均有瘤体疼痛、肿胀、增长加速等病史,彩色多普勒检查提示瘤体内血栓形成,DSA检查瘤体显影不完全;术中见瘤体内有大量血栓:术后病理检查亦证实瘤体内有大量血栓形成.结论 瘤体疼痛、肿胀、增长加速等现象是海绵状静脉畸形自发出血及栓塞的临床表现,应早期诊断,尽快治疗.     

栓塞硬化联合手术治疗阴茎头海绵状血管瘤二例报告

我们采用栓塞硬化后手术治疗阴茎头海绵状血管瘤 2例 ,效果良好 ,报告如下。例 1,2 1岁。阴茎头青紫色肿物 15年于 2 0 0 0年 5月 6日入院。入院前 3年曾在外院行肿物手术切除 ,半年后复发增大。查体 :阴茎头右前端 1.5ｃｍ×1.0ｃｍ青紫色囊性、按压可缩小包块。磁共振示阴茎头海绵状血管瘤。静脉全麻。放置气囊导尿管。阴茎头瘤体中心穿刺回血 ,用左手拇、食、中指环形压迫瘤体近端 ,分次注入 0 .2ｍｌ无水酒精见回抽液中富有凝血颗粒 ,提示瘤体回流静脉大部分栓塞 ,此时瘤体略变硬 ,共注射无水酒精 1.0ｍｌ。随即注入 10 %明矾液 2 .0ｍ…     

超选择性动脉栓塞联合手术切除治疗体表巨大血管畸形

笔者9年间手术治疗体表巨大血管畸形62例，对其中14例蔓状血管瘤患者术前在DSA下行超选择性供瘤动脉栓塞，栓塞后48h手术切除。经上述方法栓塞后，瘤体体积和血流量明显减少，病变边界清楚，可最大限度保留正常组织，术中未发生大出血，完整地切除了巨大蔓状血管瘤。术后随访患者3个月至9年，无复发，生活工作均正常。提示沿病灶周围“安全平面”进行手术是保证巨大蔓状血管畸形根治性切除的前提。术前超选择性供瘤动脉栓塞联合手术切除是治疗巨大蔓状血管畸形的有效方法。     

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目的 分析先天性血管畸形的治疗经验。方法 从1995年7月至2003年5月上海第二医科大学附属第九人民医院共治疗先天性血管畸形204例，其中先天性动静脉瘘58例，海绵状血管瘤72例，静脉畸形骨肥大综合征74例。先天性动静脉瘘采用手术、栓塞和手术联合栓塞等方法进行治疗；海绵状血管瘤采用手术和手术联合Nd：YAG激光治疗；静脉畸形骨肥大综合征采用保守治疗、外侧畸形静脉和曲张静脉切除、受压的深静脉段松解和胭动脉分支结扎等治疗。结果 经过治疗的先天性血管畸形大部分在临床均能取得一定的疗效，部分病人症状复发甚至加重。结论 先天性血管畸形的治疗仍是临床所面临的难题之一，积极的并根据病情所采用的个体化和联合的治疗方法是非常必要的，常可取得一定的临床效果。     

栓塞回流静脉加平阳霉素注射治疗巨大海绵状血管瘤

硬化剂瘤腔内注射治疗海绵状血管瘤已广泛应用于临床，但对于巨大漫无边界的海绵状血管瘤，因其回流静脉非常丰富，常导致注射后大部分硬化剂很快流失，治疗效果常不肯定，是目前临床上非常棘手的难题之一。自1996年以来，笔者对25例不同部位较大的无明显边界的海绵状血管瘤进行了栓塞加硬化或栓塞硬化加手术切除治疗，疗效满意，现报道如下。     

海绵状血管瘤内压监测指导栓塞及硬化剂注射治疗

为探讨在栓塞硬化海绵状血管瘤中瘤腔内压变化规律及其意义，在２９例治疗过程中结合机械性减缓瘤体静脉回流，进行了瘤腔内压连续监测。发现：瘤腔基础内压为０．６６７～２．０ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），颈部最低；回流快者所需栓塞次数多，用量大；瘤腔内压力曲线在栓塞初始为平台波形，提示回流静脉逐一被栓塞；随后出现缓慢下降的钝峰波形，去除瘤体体表浅回流静脉机械性压迫，瘤腔内压不变，提示回流静脉全部栓塞，可注射硬化剂；最后为快速下降的锐峰波形，表明全瘤体已被栓塞硬化。治疗２９例，随访半年至３年，２６例完全消退，３例复发，未见严重并发症。本法设备操作简便，疗效高，并发症少。     

Surgical and endovascular management of arteriovenous malformation: case series from a single center

Management of arteriovenous malformation (AVM) remains a major challenge to vascular surgeons. A multidisciplinary approach was introduced in our hospital to manage these cases from October 2003 to date. This is a report of our experience in their management. A prospective study was done on all patients with symptomatic AVM admitted to our unit between October 2003 and May 2006. All patients had preoperative duplex scanning and magnetic resonance imaging with or without conventional angiography. A multidisciplinary team assessed and treated these cases according to the type of malformation. Thirty-two cases were included in this study, with a mean follow-up of 18.3 months. Of these, 20 cases were predominantly venous and treated with surgical excision (n = 14) or ethanol sclerotherapy (n = 6). Twelve cases were predominantly arterial or arteriovenous shunting; 10 were treated with preoperative embolization followed by surgical excision and the remaining 2 with superselective embolization alone. The overall complication rate was high (31%). However, all were minor and settled down conservatively. No recurrence was observed in the early follow-up period. Management of AVM by a surgical and endovascular approach can deliver excellent results, with acceptable morbidity and no recurrence in the early follow-up period.     

Ethanol sclerotherapy for treatment of venous malformations of face and neck— a single centre experience

Due to complicated anatomy of the face and neck, complete surgical excision of venous malformation is rarely possible and may lead to bleeding, nerve damage and cosmetic deformity. Sclerotherapy is an alternative method of treatment with few complications. Ethanol shows the lowest rate of malformation recurrence and is the most reliable substance of all of the sclerosing agents. This study aims to evaluate the efficacy of ethanol instillation in venous malformation of the face and neck. Between July 20, 2008, to December 30, 2009, 15 patients with venous malformation of the face and neck were included in the study. After confirmation of diagnosis (combination of history, physical findings and magnetic resonance imaging), percutaneous ethanol (99.5% ethyl alcohol) sclerotherapy was used under DSA road mapping using general anaesthesia. Sclerotherapy provided significant improvement of symptoms for all patients, with no major complications. All patients experienced pain and swelling to a variable degree in the immediate post procedure period that resolved over few days. Ethanol sclerotherapy for venous malformations of the face and neck is a safe and effective treatment option.     

The pelvic venous syndromes: analysis of our experience with 57 patients

BACKGROUND: The pelvic venous syndromes comprise a group of poorly understood disorders of the pelvic and gonadal venous circulation. The objective of this paper was to review our experience with the pelvic venous syndromes and, in the light of the current literature, make management recommendations. Materials and Methods: Fifty-seven female patients (age range, 24 to 48 years; mean, 34 years) with symptoms of pelvic pain, dysuria, dysmenorrhea, dyspareunia, and the presence of vulval and pelvic varices were studied. Diagnosis included physical examination, Doppler scan, duplex ultrasound scan, computed tomography, magnetic resonance imaging, and retrograde cinevideoangiography. The symptoms were classified as: 1, mild (n = 15); 2, moderately severe (n = 19); and 3, severe (n = 23). Group 1 was treated with sclerotherapy/local excision of vulval varices. Group 2 had gonadal vein resection (GVR; n = 12) and sclerotherapy or gonadal vein coil embolization (GVE; n = 7) and sclerotherapy. Only the incompetent side was treated. Patients in group 3 with isolated hypogastric vein tributary reflux were treated either with hypogastric vein tributaries division (HVTD) or with embolization (HVTE) as the only procedure. Those with combined gonadal and hypogastric vein reflux were treated with HVTE followed by GVR. The follow-up period ranged from 2.5 to 24 years (mean GVR/HVTD, 12.4 years; mean GVE/HVTE, 2.3 years). Pain improvement was assessed with a visual analog scale and through mailed questionnaires (response rate, 100%). Patient results were classified as excellent (asymptomatic), moderate (mild discomfort), or no improvement. RESULTS: In group 1, 12 patients had excellent results and three had moderate results. In group 2, 10 patients treated with GVR had excellent results, one had moderate results, and one had no improvement. Three patients treated with GVE were asymptomatic, and four had no improvement. In group 3, three patients treated with HVTD were asymptomatic and two had no improvement. Five patients treated with HVTE were asymptomatic, and one had no improvement. Of the 12 patients treated with HVTE and GVR, 10 were asymptomatic, one had moderate results, and one had no improvement. CONCLUSION: Local excision of vulval varices and sclerotherapy were sufficient in patients with mild symptoms. Gonadal vein excision produced better results than GVE. In patients with isolated hypogastric vein reflux, embolization was a better option than surgical treatment. GVR preceded by embolization of the incompetent tributaries of the internal iliac vein was indicated in patients with combined reflux and severe symptoms. Supplemental sclerotherapy of vulval varices is recommended after control of the intrapelvic reflux.     

Unusual clinical manifestations of dural arteriovenous malformations

Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.     

Cavernous malformations of the brain stem

Once they become symptomatic, cavernous malformations of the brain stem appear to cause progressive morbidity from repetitive hemorrhage, and can even be fatal. Twenty-four patients with long-tract and/or cranial nerve findings from their cavernous malformations of the brain stem were seen for initial evaluation or surgical consultation and thereafter received either surgical or continued conservative treatment. The decision to operate was based on the proximity of the cavernous malformation to the pial surface of the brain stem, the patient's neurological status, and the number of symptomatic episodes. Sixteen patients were treated by definitive surgery directed at excision of their malformation. In four patients, associated venous malformations influenced the surgical approach and their recognition avoided the risk of inappropriate excision of the venous malformation. Although some of the 16 patients had transient, immediate, postoperative worsening of their neurological deficits, the outcome of all except one was the same or improved. Only one patient developed recurrent symptoms: a new deficit 2 1/2 years after surgery required reoperation after regrowth of the cavernous malformation. She has been neurologically stable since the second surgery. One patient died 6 months postoperatively from a shunt infection and sepsis. The eight conservatively treated patients are followed with annual magnetic resonance imaging studies. One has a dramatic associated venous malformation. Seven patients have either minor intermittent or no symptoms, and the eighth died from a hemorrhage 1 year after his initial presentation. Based on these results, surgical extirpation of symptomatic cavernous malformations of the brain stem appears to be the treatment of choice when a patient is symptomatic, the lesion is located superficially, and an operative approach can spare eloquent tissue. When cavernous malformations of the brain stem are completely excised, cure appears permanent.     

Direct percutaneous ethanol instillation for treatment of venous malformation in the face and neck.

Venous malformations of the face and neck involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult; high recurrence rates and high morbidity are well documented. Various methods of treatment of uncertain value and risk of complications have been advocated. We present our experience in treating five patients with venous malformation in the face and neck by using direct percutaneous ethanol sclerotherapy. Four patients had large lesions (> or = 3 cm; one patient had two large lesions in the low eyelid), and the other had a mid-sized lesion (1.5-3 cm). Under general or local anaesthesia, one-third to one-quarter cavity volume of ethanol was injected percutaneously, directly into the malformation with under fluoroscopy [de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg 1995;30:188-93; Johnson PL, Eckard DA, Brecheisen MA, Girod DA, Tsue TT. Percutaneous ethanol sclerotherapy of venous malformations of the tongue. Am J Neuroradiol 2002;23:779-82; Pappas DC Jr, Persky MS, Berenstein A. Evaluation and treatment of head and neck venous vascular malformations. Ear Nose Throat J 1998;77:914-22; Lee CH, Chen SG. Direct percutaneous ethanol sclerotherapy for treatment of a recurrent venous malformation in the periorbital region. ANZ J Surg. 2004;74(12):1126-7.]. Four patients required two injections. All patients had remission and alleviation of their symptoms, with no major complications. Direct percutaneous injection of absolute ethanol provides a simple and reliable alternative treatment for venous malformation in the face and neck.     

New approaches to the treatment of congenital vascular malformations (CVMs)--a single centre experience.

OBJECTIVE: A retrospective review of the results of management of congenital vascular malformation (CVM) patients was made to assess the efficacy of newly introduced approaches. METHODS: CVMs were categorised according to the Hamburg classification on the basis of minimally invasive tests. Invasive studies such as angiography are used to provide a road map for treatment. A new multidisciplinary approach was adopted, which accepts the integration of embolisation and sclerotherapy with traditional surgical therapy. Embolo-sclerotherapy was used as an independent therapy and as an adjunctive therapy to surgery. RESULTS: Ninety-nine out of a total of 294 venous malformation patients underwent ethanol sclerotherapy with an immediate success rate of 98.8%, requiring 419 sessions of treatment. Interim results were excellent with no evidence of recurrence (mean follow-up 18.2 months). Most of the 25 patients treated surgically received pre-operative embolo-sclerotherapy, each with excellent interim results and minimum morbidity (mean follow-up 21.2 months). Forty-eight patients among 76 arteriovenous malformation patients underwent embolo-sclerotherapy independently (32/48) or adjunctively (16/48). Independent therapy on 32 produced excellent interim results (25/32) requiring a total of 171 sessions (mean follow-up 19.2 months). Eighty-nine extratruncal (ET) forms of lymphatic malformations received multiple sessions of sclerotherapy with OK-432 (108/120 sessions) or ethanol (12/20 sessions). OK-432 was used in 51 paediatric patients with the ET form and produced an excellent response in cystic type lesions (40/45) requiring 61 sessions with no evidence of recurrence (mean follow-up 24.2 months), whereas a mixed result was obtained in the cavernous type (3/6). OK-432 sclerotherapy was used as a pre-operative adjunctive therapy in 7 patients requiring 21 sessions with 17 cavernous type of the ET form, and produced good to excellent results after surgical excision of 14 lesions. CONCLUSION: New approaches to the treatment of CVMs based on a multidisciplinary approach can improve results by fully combined surgical treatment with embolo-sclerotherapy.     

Outcomes of sclerotherapy and embolization for arteriovenous and venous malformations

Vascular malformations result from an arrest of development of a normal vascular structure or from abnormal growth of a vascular structure. Treatment continues to be a challenge. We sought to study the outcomes of sclerotherapy and embolization for vascular malformations. We reviewed clinical data of all patients treated with sclerotherapy or embolization for arteriovenous or venous malformations between 2006 and 2010 at Mayo Clinic. Follow-up information was obtained from clinical charts and a questionnaire sent to all patients. Overall, 60 patients (24 male and 36 female; mean age 31.7 years; range, 5.6 to 72.4 years) had 163 unique sclerotherapy or embolization procedures for lesions involving the lower extremity (55%), upper extremity (18.3%), pelvis (11.7%), abdomen (5%), chest (5%), back (3.3%), and multiple locations (1.7%). Thirty-one patients had low-flow venous malformations and 29 patients had high-flow arteriovenous malformations. Twenty-four patients required more than three sessions. The most common indication for intervention was pain (57 of 60 [95%]). Sixteen patients (27%) had documented or patient-reported complications. There was no significant difference in complication rates or lesion size between patients with low-flow or high-flow lesions. There were no procedural deaths. Mean available follow-up was 2.0 ± 1.3 years (range, 0.5 to 5.0 years). Median pain scores at most recent follow-up decreased significantly (P<.001). Eighty-three percent of the responders (24 of 29) would recommend treatment to others. With appropriate patient selection, sclerotherapy and embolization can decrease the pain of patients with arteriovenous and venous malformations. Multiple interventions might be necessary. Practitioners should be aware of the potential complications and counsel their patients about these risks.     

儿童颅骨膜血窦的诊断与治疗

目的 探讨儿童颅骨膜血窦的诊断和治疗方法,以减少并发症的发生.方法 回顾性分析2000年1月至2008年12月收治的12例颅骨膜血窦患儿的临床资料和CT表现,对有与颅内血管联系的,加做DSA,以了解静脉引流情况.治疗以手术切除肿块为主,用电烧颅骨孔或骨蜡压迫止血,如果颅骨内出血仍未止住,可把颅骨外板切开电磨和电烧止血或开颅止血.以局部皮瓣修复颅骨缺损.结果 12例均有随体位改变而变化的头皮肿块.CT表现颅骨外板外头皮下软组织密度肿块,与周围组织分界清晰;增强扫描后明显强化,有粗大血管从肿块间通过,骨窗均可显示颅骨的孔状缺损;三维成像显示病变部位有血管进入颅骨的单个或多个小缺损.对伴有颅内静脉窦畸形的6例加做DSA检查,结果显示均为侧支型.12例均接受手术,术后6个月随访,无复发.结论 儿童颅骨膜血窦具有典型的CT表现,结合患者特征性临床表现,对该病能作出明确诊断.目前治疗有手术、栓塞、观察等方法.对有和颅内血管联系的,加做DSA,以明确引流情况,若是主要引流静脉则不能手术,只能观察.药物注射治疗风险极大,应设为禁忌证.