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。     

生物胶联合OK-432及博莱霉素治疗颌面部软组织动静脉畸形13例临床分析

目的 评价生物胶联合OK-432及博莱霉素治疗颌面部软组织动静脉畸形（arteriovenous malformations,AVMs）的临床疗效。方法 13例颌面部软组织AVMs患者,男8例,女5例,平均年龄28.2岁。在超选择性血管内栓塞基础上,通过经皮注射生物胶联合OK-432及博莱霉素3~5次进行硬化治疗。结果 除术区1周内肿胀外,均无严重并发症出现。随访14~58个月（平均27.4个月）,3例治愈,8例显效,2例有效,无无效病例。结论 生物胶联合OK-432及博莱霉素经皮硬化治疗术治疗颌面部软组织AVMs效果良好,方法简单、安全、可靠。     

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淋巴管畸形是常见于头颈部的一种先天性发育畸形。临床上常用的治疗方法主要有手术切除、硬化治疗、激光治疗等,可根据病变类型和病变范围选择其中一种方法或几种方法联合应用。口腔黏膜的微囊型淋巴管畸形适用激光治疗、平阳霉素注射或几种方法联合治疗。累及口腔和面颈部的淋巴管畸形的治疗困难较多,弥漫性病变手术切除后易复发,并发症发生率高。病变内注射平阳霉素、溶血性链球菌制剂(OK-432)可用于淋巴管畸形的治疗,大囊型病变的疗效明显优于微囊型。围手术期硬化治疗可提高微囊型病变的治愈率。     

OK-432治疗淋巴管瘤的研究进展

淋巴管瘤是一种淋巴系统的先天性发育畸形,多发生在头颈部,约有90％的病变在2岁内发生。由于广泛的病变手术切除不易彻底,而且切除后可能导致严重的并发症,因而人们一直在探索有效的非手术治疗。近年来,一种新的治疗方法,OK-432硬化治疗受到临床研究者的重视。本文回顾了有关OK-432治疗淋巴管瘤的研究进展,并简要描述了其机理、方法和并发症。     

口腔颌面部淋巴管畸形的治疗

根据ISSVA、Waner和Suen的分类,过去所称的淋巴管瘤现统称为淋巴管畸形,包括微囊型和大囊型2类,以头颈部最多见。其发病原因不清,治疗方法多样。本文复习新近文献,论述了淋巴管畸形的手术治疗、硬化治疗、激光治疗的适应证、优缺点等,并介绍了其分子生物学研究和治疗前景。认为淋巴管畸形虽属良性病损。但极少自然消退,常与头颈部重要结构毗邻且具有局部浸润性而引起严重并发症和高复发率,给临床治疗带来了很大困难。虽然目前可用的治疗方法很多,但均有优点与不足,应根据患者病情和技术条件,制定个体化治疗方案。采用综合治疗．以期获得最佳疗效。对黏膜表面的微囊型淋巴管畸形、面颈部大囊型淋巴管畸形,平阳霉素、OK-432等病变内注射可获得良好的效果。黏膜表面的微囊型淋巴管畸形,也适于激光治疗。组织深部的微囊型淋巴管畸形的治疗。仍然是临床上面临的难题。目前不主张毫无指征地对任何类型的淋巴管畸形进行手术切除,手术适用于局限的、黏膜表面的微囊型淋巴管畸形和面颈部大囊型淋巴管畸形的治疗。手术中应注意重要结构的辨别和保护。对于复杂病例,提倡采用综合序列治疗。     

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。     

纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部静脉畸形的远期疗效观察

目的:评价纤维蛋白胶复合平阳霉素栓塞硬化治疗面颈部静脉畸形的临床效果。方法:回顾2005年1月—2012年1月应用纤维蛋白胶复合平阳霉素栓塞硬化技术治疗的78例面颈部静脉畸形患者资料。63例患者接受纤维蛋白胶/平阳霉素栓塞硬化+平阳霉素注射治疗,15例患者除上述治疗外,还接受了无水乙醇硬化、射频消融或手术治疗。治疗后观察患者生命体征及症状,拍摄胸片了解肺部情况。通过临床观察、B超、MRI检查评价治疗效果。随访时间6个月～7 a。结果:78例患者中,男41例,女37例;年龄10岁～66岁(平均26岁)。67例(85.9%)病变消退率大于90%,11例(14.1%)大于50%。6例患者出现高热,未发现过敏反应、肺栓塞或其他并发症。结论:纤维蛋白胶/平阳霉素栓塞硬化技术安全、有效,并发症在可接受范围,适用于治疗大范围、高回流静脉畸形。     

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。     

聚桂醇硬化剂治疗口腔颌面部血管瘤和脉管畸形专家共识

[提要] 血管瘤和脉管畸形是一组复杂的来源于脉管系统的疾病。婴幼儿血管瘤以内皮细胞增殖为特征,是最常见的婴幼儿良性肿瘤。脉管畸形是胚胎发育时期脉管系统发育异常所致,超过60%的脉管畸形发生于头颈部。血管瘤和脉管畸形可能引起严重的面部畸形和功能障碍,硬化治疗是其常用的治疗方法。过去常用的硬化剂有平阳霉素、博来霉素、无水乙醇、十四烷基硫酸钠、OK-432、强力霉素、鱼肝油酸钠等。近年来,国产硬化剂聚桂醇被广泛用于血管瘤和脉管畸形的治疗,泡沫化硬化治疗技术的发展推动了其临床应用,其治疗有效性和安全性已被大量研究所证实。为了进一步规范该技术的应用,我们组织专家制定了该专家共识。今后将依据最新出版的文献和临床治疗经验及时更新,为该领域的临床医师提供指导。     

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.     

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.     

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目的评价不同浓度平阳霉素局部注射治疗口腔颌面部淋巴管畸形的临床疗效。方法回顾分析2006年1月至2013月5月在中国医科大学附属口腔医院口腔颌面外科采用平阳霉素局部注射治疗的82例淋巴管畸形患者的临床资料。对不同类型、同一类型不同大小的淋巴管畸形采用不同浓度的平阳霉素治疗,具体如下：微囊型淋巴管畸形为8 mg/8 mL;病损直径〈5 cm的大囊型及混合型淋巴管畸形为8 mg/5 mL;病损直径〉5 cm的大囊型淋巴管畸形为8 mg/3 mL。随访时间为6个月至3年。结果微囊型淋巴管畸形治愈率为43.3%;病损直径〈5 cm的大囊型淋巴管畸形治愈率为93.3%;病损直径〉5 cm的大囊型淋巴管畸形治愈率为88.9%;混合型淋巴管畸形的治愈率为60.0%。所有患者术后均出现局部肿胀、疼痛,出现全身发热4例,出现局部溃疡1例,均未见肺纤维化及严重不良反应发生。结论对不同类型、同一类型不同大小的淋巴管畸形采用适宜浓度的平阳霉素进行治疗,不仅可以提高疗效、缩短疗程,而且可以减少不必要的并发症发生,治疗相对安全。     

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。