颌骨动静脉畸形的血管造影分型初探及治疗分析

目的分析颌骨动静脉畸形(AVM)的普通X线和数字减影血管造影(DSA)表现，并对其血管构筑分型，探讨该分型对颌骨AVM治疗的指导意义。方法分析25例颌骨AVM的普通X线和DSA表现，包括颌骨骨质改变、供血动脉、畸形血管团和引流静脉特点，从而对颌骨AVM的血管构筑分型。分析各型颌骨AVM的治疗史和疗效。结果25例颌骨AVM的DSA表现可分为5型：Ⅰ型：弥散型(5例)，Ⅱ型：单静脉腔型(8例)，Ⅲ型：弥散单静脉腔型(7例)，Ⅳ型：多静脉腔型(2例)，Ⅴ型：弥散多静脉腔型(3例)。DSA分型与普通X线表现具有很好的对应性。DSAⅡ～Ⅳ型治疗效果较好，17例均临床治愈(100％)；DSA Ⅰ型和V型疗效较差，临床治愈的病例分别为3例(3／5)、1例(1／3)。结论颌骨AVM的血管构筑特点具有多样性，建议分为5型；该分型对颌骨AVM的治疗具有一定的指导意义。

A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws

OBJECTIVE: To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options. METHODS: X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options. RESULTS: The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively. CONCLUSIONS: Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.