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。     

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。     

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。     

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。     

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。     

翻瓣激光联合平阳霉素注射治疗口腔颌面部静脉畸形36例报道

目的：评价翻瓣激光联合平阳霉素注射治疗口腔颌面部静脉畸形的疗效及安全性。方法：先以外科手术翻瓣显露病变,应用Nd：YAG激光照射凝固静脉畸形病灶,使病变萎缩消退,残余病变配合平阳霉素注射治疗。共治疗36例13腔颌面部静脉畸形患者。随访1～84个月,平均随访时间42．5个月,治疗前、后经临床及影像学检查进行评估。结果：显效29例,占80．6％;有效7例,占19．4％;总有效率100％,无复发病例。22例腮腺咬肌区及面颊部静脉畸形患者中,5例出院时伴部分面神经损伤症状。术后随访观察3个月,经Buttes—Fisch面神经评分系统评估,3例得分为100分,完全恢复;2例分别获得94．7、98分,大部分恢复正常。结论：翻瓣激光结合平阳霉素注射治疗口腔颌面部静脉畸形,疗效及安全性满意。     

综合疗法治疗巨大颌颈部静脉畸形16例临床报告

目的:探讨巨大颌颈部静脉畸形综合治疗的方法及其疗效.方法:总结2000年来收治的巨大颌颈部静脉畸形16例,男5例,女11例,年龄14～60岁;位于颌面部5例,颈部7例,颌颈部4例;瘤体范围最小8cm×5cm,最大12cm×9cm.治疗方法:①手术切除瘤体主要部分,缝扎残留部,注射鱼肝油酸钠或平阳霉素.②平阳霉素、地塞米松和鱼肝油酸钠三药联合注射,5～7d注射1次,3～5次为一疗程,未愈者可重复治疗.结果:经6～48个月随访,Ⅳ级13例(81.1%),Ⅲ级2例(12.5%),Ⅱ级1例(6.3%).有效率100%.结论:采用综合疗法治疗巨大颌颈部静脉畸形是一种安全、可靠、较为理想的方法.     

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。     

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。     

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.     

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。