数字减影血管造影及栓塞术在耳鼻咽喉-头颈外科血管性疾病中的应用

目的探讨数字减影血管造影(DSA)及栓塞术在耳鼻咽喉-头颈外科血管性疾病诊断及治疗中的应用价值。方法回顾性分析35例患者的临床资料,其中,鼻咽纤维血管瘤27例,上颌窦血管瘤4例,难治性鼻出血4例(其中自发性颈内动脉海绵窦瘘1例,鼻咽癌放疗后难治性鼻出血1例)。均采用Seldinger技术动脉插管行DSA、栓塞进行诊断和治疗,分析DSA及栓塞术在该类疾病中的应用价值。结果 35例均成功进行DSA及栓塞治疗。单纯栓塞治疗的5例中,颈内动脉海绵窦瘘1例及其他难治性鼻出血3例均一次栓塞治愈,1例鼻咽纤维血管瘤Ⅳ期因颅底广泛破坏和颈内动脉供血仅行姑息性栓塞后影像学检查证实瘤体明显缩小。余26例鼻咽纤维血管瘤及4例上颌窦血管瘤栓塞后再予手术治疗,28例术中出血量明显减少,平均出血量仅470 ml,2例Ⅳ期鼻咽纤维血管瘤因由颈内、外动脉同时供血单纯行颈外供瘤动脉栓塞,术中出血量较多。结论 DSA能清晰显示头颈部血管性病变的供血动脉、异常交通支、动静脉瘘等动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘有良好的治疗效果;对血运丰富需手术治疗的肿瘤,术前栓塞可显著减少术中出血,大大提高手术的安全性。

Application of DSA and embolization for vascular lesions in otorhinolaryngology-head and neck surgery

Objective To evaluate the application value of digital subtraction angiography （DSA） and embolization on diagnostic and treatment for vascular diseases in otorhinolaryngology-head and neck surgery. Methods The clinical data of 35 patients including 27 cases of nasopharyngeal angiofibroma,4 cases of maxillary sinus aneurysm and 4 cases of refractory epistaxis （ containing＇l case of spontaneous internal carotid cavernous fistula complicated with nasal massive hemorrhage and 1 case of nasopharyngeal carcinoma complicated with refractory epistaxis after radiotherapy）were retrospectively analyzed. The diagnosis and treatment were carried out by DSA and embolization using transarterial catheterization with seldinger technique. The applied value of DSA and embolization in these diseases was analyzed. Results The DSA and embolization succeeded in all the patients. Among 5 cases treated by simple embolization, the healing only once was seen in 1 case of internal carotid cavernous fistula and other 3 cases of refractory epistaxis, and in the other l case of nasopharyngeal angiofibroma, the tumor volume was obviously decreased （confirmed by image examination）after performing palliative embolization only owing to extensive destruction of base of skull and internal carotid artery blood-supply. In the rest of 26 cases of nasopharyngeal angiofibroma and 4 cases of maxillary sinus aneurysm, the operations were all performed after embolization;in them, the intra-operative bleeding volume decreased obviously with mean bleeding volume of 470 ml in 28 cases ;2 cases of nasopharyngeal angiofibroma IV stage with both internal and external carotid arteries blood-supply had more intra-operative bleeding volume owing to performing embolization of external carotid only. Conclusions DSA can clearly show dynamic images of blood-supply artery, abnormal communicating branch and arterio-venous fistula in the head-neck vascular lesions and guide the choice of therapeutic method. Intravascular embolization has good therapeutic effect to refractory epistaxis of external carotid system and internal carotid cavernous fistula, and preoperative embolization can obviously decrease intra-operative bleeding and enhance safety of operation immensely for tumors with rich blood supply and needing surgery.