Konas Ersoy, Canter Halil Ibrahim, Cil Barbaros, Peynircioglu Bora, Karabulut Erdem, Tuncbilek Gokhan, Kayikcioglu Aycan, Erk Yucel
Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
J Craniofac Surg. 2009 Mar;20(2):402-5. doi: 10.1097/SCS.0b013e31819b9400.
Treatment of large soft tissue vascular lesions, one of the greatest challenges facing plastic surgeons, is patient specific in almost all cases, and preoperative angiographic evaluation and embolization of these lesions are standards of care. The aim of this study was to evaluate the usefulness of 3-dimensional demonstration and volumetric assessment of soft tissue vascular lesions both in the treatment of these lesions with curettage and in the participation of the patients to the decision-making process of the disease. Five patients with vascular malformation of the head and neck regions were included to this prospective trial. All patients were evaluated with preoperative angiography, and selective embolizations of the soft tissue vascular lesions were done in the same session by the same interventional radiologists. The amount of embolic agent injected was determined according to the size and vascularization of the lesions. Surgery was done by curettage of the embolized lesions 7 to 10 days after the embolization procedure. The raw data obtained from preoperative and postoperative high-resolution computed tomographic scans of the patients were processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). Volume and surface area of the injected embolic agent were assessed. Statistical analysis was performed using the software package SPSS 10.0 for Windows (SPSS Inc, Chicago, IL). Wilcoxon signed rank test was used to compare the measurements of the volume and the surface area of injected sclerosing agent preoperatively and postoperatively. There were no complications related to either the preoperative angiography or embolization procedure. All the patients emphasized (assessed) that the 3-dimensional demonstration of the lesions and their relation with other anatomic structures helped them to understand the extent of their pathology and aim of the proposed treatment. The difference between the volumetric measurements before and after the treatment was found statistically significant. Treatment of large soft tissue vascular lesions with curettage after embolization has acceptable cosmetic results. Although it is not possible to remove all of the sclerosing agent from its injection site with this technique, a significant amount of it can be removed, and the 3-dimensional vascular architecture of the lesion is disturbed. Reactive chronic inflammation against the remaining sclerosing agent and the intralesional scarring caused by curettage lead to further improvement. Using 3-dimensional imaging modalities helps patients and/or their relatives to understand their disease and participate in the decision-making process.
大型软组织血管病变的治疗是整形外科医生面临的最大挑战之一，几乎在所有情况下都因患者而异，术前血管造影评估和这些病变的栓塞是标准治疗方法。本研究的目的是评估软组织血管病变的三维演示和体积评估在刮除治疗这些病变以及患者参与疾病决策过程中的作用。五名头颈部血管畸形患者被纳入这项前瞻性试验。所有患者均接受术前血管造影评估，由同一位介入放射科医生在同一疗程中对软组织血管病变进行选择性栓塞。根据病变的大小和血管化程度确定注入的栓塞剂用量。栓塞术后7至10天通过刮除栓塞病变进行手术。患者术前和术后高分辨率计算机断层扫描获得的原始数据使用Mimics 9.22软件（比利时鲁汶Materialise公司的交互式医学图像控制系统）进行处理。评估注入栓塞剂的体积和表面积。使用Windows版SPSS 10.0软件包（SPSS公司，伊利诺伊州芝加哥）进行统计分析。采用Wilcoxon符号秩检验比较术前和术后注入硬化剂的体积和表面积测量值。术前血管造影或栓塞过程均未出现并发症。所有患者都强调（评估）病变的三维演示及其与其他解剖结构的关系有助于他们了解病变的程度和拟议治疗的目的。治疗前后体积测量值的差异具有统计学意义。栓塞后刮除治疗大型软组织血管病变具有可接受的美容效果。虽然用这种技术不可能从注射部位清除所有硬化剂，但可以清除大量硬化剂，并且病变的三维血管结构会受到干扰。对残留硬化剂的反应性慢性炎症以及刮除引起的病灶内瘢痕形成会导致进一步改善。使用三维成像方式有助于患者和/或其亲属了解病情并参与决策过程。
