下颌骨动静脉畸形的乙醇栓塞术
Ethanol embolization of arteriovenous malformations of the mandible.
作者信息
Fan X D, Su L X, Zheng J W, Zheng L Z, Zhang Z Y
机构信息
Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China.
出版信息
AJNR Am J Neuroradiol. 2009 Jun;30(6):1178-83. doi: 10.3174/ajnr.A1539. Epub 2009 Mar 6.
BACKGROUND AND PURPOSE
Absolute ethanol was reported as an effective embolization of arteriovenous malformations (AVMs), but its use to treat AVMs in the mandible is not yet well established. Here, we present our clinical experience on treatment of mandibular AVMs with absolute ethanol.
MATERIALS AND METHODS
Eight consecutive patients with symptomatic AVMs of the mandible between August 2007 and September 2008 were enrolled in this study group. Among them, 6 patients underwent direct puncture embolization with absolute ethanol combined with coils, 1 patient underwent direct puncture embolization with absolute ethanol only, and the last patient had transarterial embolization with absolute ethanol alone. The use of coils decreased the flow and volume of the nidus, and then absolute ethanol embolization was directed against and obliterated the nidus completely. The procedure was performed with the patients under general anesthesia with nasal intubation, and the vital signs of the patients were constantly monitored during the injection of absolute ethanol. The total amount of absolute ethanol used per session was less than 1 mL/kg of body weight.
RESULTS
A total of 11 ethanol embolizations were performed on 8 patients, including 3 sessions with transarterial microcatheterization and 8 with direct puncture embolization. A venogram and control arteriogram performed immediately after the procedure were both obtained, which documented a significant thrombosis of the lesion in all patients. Follow-up examinations revealed that oral bleeding was controlled, the expansion of the external jugular vein in 5 cases was obliterated, and satisfactory shrinkage of the facial swelling was achieved. Follow-up angiography (mean, 4.2 months) was available in 4 patients, and there was no angiographic recurrence of the lesions. There were 3 cases with minor complications.
CONCLUSIONS
On the basis of our experience, treatment of AVMs in the mandible with absolute ethanol is a feasible, safe, and highly effective method.
背景与目的
无水乙醇被报道为治疗动静脉畸形（AVM）的有效栓塞剂，但用于治疗下颌骨AVM的效果尚未完全明确。在此，我们介绍使用无水乙醇治疗下颌骨AVM的临床经验。
材料与方法
2007年8月至2008年9月期间，连续8例有症状的下颌骨AVM患者纳入本研究组。其中，6例患者接受无水乙醇联合弹簧圈直接穿刺栓塞，1例患者仅接受无水乙醇直接穿刺栓塞，最后1例患者仅接受无水乙醇经动脉栓塞。使用弹簧圈可减少畸形团的血流和体积，然后针对畸形团进行无水乙醇栓塞并将其完全闭塞。手术在全身麻醉经鼻插管下进行，注射无水乙醇期间持续监测患者生命体征。每次使用的无水乙醇总量小于1 mL/kg体重。
结果
8例患者共进行了11次乙醇栓塞，包括3次经动脉微导管栓塞和8次直接穿刺栓塞。术后立即进行了静脉造影和对照动脉造影，结果显示所有患者病变均有明显血栓形成。随访检查显示，口腔出血得到控制，5例患者颈外静脉扩张消失，面部肿胀明显消退。4例患者进行了随访血管造影（平均4.2个月），病变无血管造影复发。有3例出现轻微并发症。
结论
根据我们的经验，无水乙醇治疗下颌骨AVM是一种可行、安全且高效的方法。
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