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.     

颌面部动静脉畸形的临床分型与治疗

目的探讨颌面部动静脉畸形(arteriovenous malformation,AVM)的临床分型与治疗方法。方法106例颌面部AVM患者根据病变表现特点分为四种类型,其中囊状扩张型38例,局限增厚型22例,弥漫增厚型42例,颌骨中心型4例。106例患者分别采用手术治疗8例(Ⅰ组),单纯供血动脉栓塞23例(Ⅱ组),供血动脉栓塞加瘤内硬化剂注射37例(Ⅲ组),供血动脉栓塞加瘤体切除38例(Ⅳ组)。结果全组病例随访1-11年,Ⅰ、Ⅱ、Ⅲ、Ⅳ组的治愈率分别为62．50％、17．39％、89．19％、97．37％。1例患者栓塞治疗时并发脑异位栓塞死亡。结论新的临床分型有利于治疗方法的选择。优良的数字减影血管造影是颌面部AVM必不可少的决定性检查。单纯供血动脉栓塞仅能治愈单支终末供血的局限性病变,而多支动脉供血的病变单纯栓塞后容易复发。供血动脉栓塞加瘤内硬化剂注射或供血动脉栓塞加病变切除是颌面部AVM的有效治疗方法。     

介入栓塞术联合术后注射无水乙醇治疗颌面部动静脉畸形

目的：探讨以数字减影成像显影下血管介入栓塞技术联合术后注射无水乙醇治疗颌面部动静脉畸形的疗效。方法：对6例颌面部动静脉畸形患者行血管介入造影检查,并超选择性插管栓塞供血动脉及病灶,注入聚乙烯醇颗粒、无水乙醇等栓塞剂栓塞畸形血管团,术后根据恢复情况定期在病灶血管腔内注射无水乙醇。结果：6例颌面部动静脉畸形患者均栓塞成功,达到临床治疗目的,无严重并发症发生。结论：血管介入造影下超选择性插管栓塞联合术后无水乙醇是治疗颌面部动静脉畸形的一种有效、安全的方法。     

介入动脉栓塞治疗顽固性鼻出血

目的探讨鼻出血介入治疗的临床效果、并发症及注意事项。方法采用介入治疗技术及数字减影血管造影(DSA)技术,对64例顽固性鼻出血患者进行超选择性上颌动脉和/或面动脉栓塞。结果60例患者达到立即止血目的,4例因合并筛动脉出血,栓塞后再经筛动脉结扎,出血得到控制,1例患者于栓塞后40分钟患侧视力逐渐丧失,8h后经眼动脉溶栓治疗,眼动脉恢复血运,但视力未恢复。结论在数字减影技术和介入治疗技术下,对顽固性鼻出血进行超选择性动脉栓塞是有效、快捷的止血方法,但对由筛前、筛后动脉所致的鼻出血应配合动脉结扎手术,并注意眼动脉血栓形成的可能。     

体表巨大血管畸形的介入诊断分型及治疗

目的：研究体表巨大血管畸形的介入诊断和治疗方法。方法：对32例体表巨大血管畸形患者进行介入治疗,瘤体位于颌面部、躯干、四肢等处。在透视下经股动脉穿刺,导丝引导下插入微导管至病变部位,注射造影剂碘海醇,根据血管特征,分为动静脉瘘或静脉畸形或混合血管畸形等不同类别,对于动静脉瘘以NBCA胶或明胶栓塞治疗,对于静脉畸形则向病变内部注射碘油＋平阳霉素＋明胶海绵颗粒混合物。结果：动静脉畸形和静脉畸形分别进行栓塞或硬化治疗后,病变区域皮肤颜色变浅,患者48h内局部均有肿胀感甚至疼痛,瘤体逐步萎缩变小,血管搏动减弱或消失。结论：介入下可以对血管畸形进行准确诊断和分型,同时进行栓塞或硬化治疗可以取到良好的治疗效果,对于位于重要脏器和结构周围的巨大病变十分安全有效。     

颜面部动静脉畸形的介入治疗

目的 介绍经动脉栓塞介入治疗动静脉畸形(AVM)的方法，总结17例颜面部AVM介入治疗的效果。方法 1998年3月开始采用经皮穿刺股动脉插管，置导管于病变血管团供血动脉处，注入栓塞剂进行栓塞治疗。17例中ll例行单纯栓塞治疗，6例于栓塞后行手术切除。结果 17例患者经介入栓塞治疗后，即时造影均无异常血管显影，临床症状有不同程度的缓解。栓塞后进行手术的患者，出血量明显减少。结论 介入栓塞疗法为动静脉畸形的治疗提供了一个新的途径；手术前栓塞治疗可以明显减少术中的出血，降低手术的危险性。     

面部血管畸形栓塞术后致右眼失明一例

近年来,国内外学者用血管造影及介入栓塞治疗脉管性疾病的报道越来越多[1-5],但不同类别的脉管性疾病选用该方法治疗的情况有较大差异,且介入栓塞为侵人性治疗,尤其是在栓塞解剖结构复杂的颌面部病灶时,由于这类病变的颅内外异常交通支的存在,其术后误栓的发生率较高,2010年10月,中国医学科学院整形外科医院门诊收治1例因右面部血管畸形在外院行上、下唇动脉栓塞术后致右眼失明的患者.     

外伤性肾损伤的介入治疗

目的探讨外伤性肾损伤介入治疗的疗效和方法。方法对30例经临床、超声及CT明确诊断的单纯性肾损伤的患者，选择性肾动脉造影明确损伤的部位及出血原因后，经导管送入明胶海绵或弹簧钢圈对损伤的肾动脉行部分或完全栓塞。结果30例患者经栓塞治疗后，出血停止，未出现并发症。结论介入治疗是单纯性肾损伤安全有效的治疗方法。     

面部血管畸形栓塞术后致右眼失明一例

近年来,国内外学者用血管造影及介入栓塞治疗脉管性疾病的报道越来越多[1-5],但不同类别的脉管性疾病选用该方法治疗的情况有较大差异,且介入栓塞为侵人性治疗,尤其是在栓塞解剖结构复杂的颌面部病灶时,由于这类病变的颅内外异常交通支的存在,其术后误栓的发生率较高,2010年10月,中国医学科学院整形外科医院门诊收治1例因右面部血管畸形在外院行上、下唇动脉栓塞术后致右眼失明的患者.     

面部血管畸形栓塞术后致右眼失明一例

近年来,国内外学者用血管造影及介入栓塞治疗脉管性疾病的报道越来越多[1-5],但不同类别的脉管性疾病选用该方法治疗的情况有较大差异,且介入栓塞为侵人性治疗,尤其是在栓塞解剖结构复杂的颌面部病灶时,由于这类病变的颅内外异常交通支的存在,其术后误栓的发生率较高,2010年10月,中国医学科学院整形外科医院门诊收治1例因右面部血管畸形在外院行上、下唇动脉栓塞术后致右眼失明的患者.     

Transcatheter embolization in the treatment of massive bleeding due to maxillofacial injury

Thirty-one cases of massive bleeding due to blunt maxillofacial injuries were treated by several procedures. Blind techniques, such as nasal and/or oral packing or ligation of external carotid artery, failed to achieve hemostasis in 13 of the 18 cases (72.2%) in which they were employed before 1984. Since then, carotid angiography has documented the location of the bleeding in 12 of the 13 cases (92.3%) in which it was employed. Each of the four cases in which extravasation was visualized from the external carotid artery was successfully treated by transcatheter embolization. We conclude that selective, angiographically guided embolization can reliably achieve hemostasis in a high proportion of patients with maxillofacial injury who are in danger of exsanguination from the branches of the external carotid artery.     

外伤性颈内动脉海绵窦瘘的诊断与介入栓塞治疗（附4例报告）

[摘要]目的探讨外伤性颈内动脉海绵窦瘘的诊断和血管内治疗。方法对有头部外伤病史及典型临床表现的患者积极行数字减影血管造影（digitalsubtractionangiography,DSA）检查,有4例确诊后经股动脉入路,用可脱性球囊进行栓塞治疗。3例保持了患侧颈内动脉的通畅,1例行瘘口远近端的颈内动脉闭塞术;3例患者应用1个球囊,1例应用2个球囊。结果4例患者瘘I：1完全闭塞,临床症状缓解,1例于首次术后12h症状再发,再次行栓塞治疗后缓解痊愈。结论DSA检查是诊断颈内动脉海绵窦瘘的金标准;可脱性球囊栓塞治疗是颈内动脉海绵窦瘘的首选治疗方法。     

Multimodal endovascular treatment for traumatic carotid- cavernous fistula

bjective：To present our experience in treating traumatic carotid-cavernous fistula （TCCF） by multimodal endovascular treatment.Methods：The management of 28 patients with TCCF between January 2004 and October 2012 in our hospital was retrospectively analyzed.According to imaging charateristics,24 cases were categorized into Type Ⅰ,3 Type Ⅱ and 1 Type Ⅲ.Totally 30 endovascular treatments were performed：Type Ⅰ TCCFs were obliterated via transvenous approach （7/25）,or transarterial approach （18/25） including 6 by detachable balloon occlusion,6 by microcoil embolization,3 by Hyperglide balloon-assisted coil embolization and 3 by a combination of detachable balloon and coil embolization.Two patients were treated with closure of internal carotid artery （ICA）.Type Ⅱ TCCFs were treated with transvenous embolotherapy （2/3） or carotid artery compression therapy （1/3）.The Type Ⅲ patient underwent detachable balloon embolization.Results：Immediate postoperative angiography showed recovery in 26 cases.One recurrent TCCF was found 2 weeks after detachable balloon embolization,and then reobliterated by transarterial coils.Reexamination found balloon deflation and fistula recanalization in 1 patient one month after combination of detachable balloons and coil embolization,which was cured by a second treatment via transvenous approach.The immediate angiography revealed residual blood flow in 4 patients.Among them,2 patients with delayed symptoms at follow-up needed a second treatment,1 patient recovered after carotid artery compression therapy,and the remaining patient＇s symptoms disappeared on digital subtraction angiography at five-month follow-up.CT angiography revealed anterior communicating artery aneurysm in the patient who was treated with closure ofICA 4 years later.Conclusion：According to results of images,characteristics of the fistula and type of drainage,proper treatment approach and embolic material can maximally heal pathological changes,retain the ipsilateral ICA patency and reduce long-term complications.     

Traumatic pseudoaneurysms of external carotid artery branch: Case series and treatment considerations

PurposeTo explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms.MethodsEleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected.ResultsComplete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5–2.0 years without recurrence of nosebleed and scalp lump.ConclusionFor patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.     

Surgical results of two cases of simultaneous surgery of carotid and coronary occlusive disease]

Two cases of symptomatic extracranial carotid artery stenosis associated with ischemic heart disease are reported. The first case was 72-year-old male, who was admitted because of transient ischemic attack due to the stenosis of left internal carotid artery. He had a history of myocardial infarction and coronary angiography revealed three vessel disease. The second case was 74-year-old female with diabetes mellitus. She was admitted because of cerebral infarction. The carotid angiography revealed critical stenosis of bilateral internal carotid arteries. Her coronary angiography revealed three vessel disease. Her chest symptom became unstable after her admission. In both cases, simultaneous carotid endarterectomy and coronary bypass grafting were performed with successful outcome. In the patients with symptomatic extracranial carotid occlusive disease associated with severe ischemic heart diseases, we advocate simultaneous operation both for carotid and coronary artery occlusive disease.     

Endovascular treatment of unusual multiple aneurysms of the internal carotid artery-posterior communicating artery complex--case report

A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery (PCoA) aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery (ICA)-PCoA complex. Superselective angiography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the ICA-PCoA junction. Endovacular embolization using Guglielmi detachable coils (GDCs) was successfully performed for both aneurysms and complete occlusions were achieved with the PCoA fully patent. Embolization with GDCs is a good alternative to surgical clipping for PCoA aneurysm after careful evaluation of superselective angiography.     

选择性动脉栓塞术治疗顽固性鼻出血

目的探讨顽固性鼻出血的血管造影特点以及选择性动脉栓塞术治疗的临床疗效、并发症及注意事项。方法对16例顽固性鼻出血患者行选择性颈外和（或）颈内动脉造影术及选择性上颌动脉和（或）面动脉栓塞术。栓塞剂为明胶海绵颗粒（条）、弹簧圈。结果 16例患者中,15例动脉造影见阳性征象,1例为阴性。栓塞靶血管后,14例止血效果良好;对2例合并筛动脉出血患者于栓塞术后次日行筛动脉结扎术,出血得到完全控制。所有患者均未出现与栓塞相关的严重并发症。结论选择性动脉造影及栓塞术可快速诊断及有效治疗顽固性鼻出血;对有筛动脉参与的鼻出血,应结合动脉结扎手术进行治疗。     

Retrospective study on the endovascular embolization for traumatic carotid cavernous fistula

Objective： To retrospectively analyze 95 cases of traumatic carotid cavernous fistula treated by endovascular embolization. Methods： From January 1994 to December 2008, 95 patients with traumatic carotid cavernous fistula were treated in our hospital. All patients received selective cerebral angiography through femoral artery catheterization. Accordingly, 89 cases were treated by detachable balloon embolization, 5 by platinum microcoils and 1 by coveredstem, respectively. Results： In the study, 61 cases achieved successful balloon embolization at the first time. Fifty-six cases had multiple balloons due to the big fistula. Nine cases received balloon embolization twice. But among the 5 patients treated with platinum microcoils, one developed slight brainstem ischemia. After operation the patient had herniparesis and swallow difficulty, but gradually recovered 3 months later. No neurological deficits were observed in other cases. All the cases recovered. Eighty-five cases were followed up for 1-15 years and no recurrence was found. Conclusions： The endovascular embolization for traumatic carotid cavernous fistula is minimally invasive, safe, effective and reliable. The detachable balloon embolization is the first choice in the treatment of TCCF.