Oomen Karin P Q, Paramasivam Srinivasan, Waner Milton, Niimi Yasunari, Fifi Johanna T, Berenstein Alejandro, O Teresa M
Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery (k.p.q.o.), Weill Cornell Medical College, New York, New York, U.S.A.
Department of Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery (k.p.q.o.), University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Laryngoscope. 2016 Jan;126(1):205-11. doi: 10.1002/lary.25284. Epub 2015 May 13.
OBJECTIVES/HYPOTHESIS: To describe a multidisciplinary approach to the treatment of airway vascular malformations (venous or lymphatic) with direct suspension rigid laryngoscopy and direct puncture transmucosal bleomycin sclerotherapy injected under road-mapping fluoroscopic monitoring, supplemented by Dyna-computed tomography utilization.
Case series.
We performed a retrospective medical record and imaging review of four patients with venous malformations or lymphatic malformations located in the airway. Patients were treated with a combination of direct suspension laryngoscopy or rigid nasopharyngoscopy and image-guided direct puncture bleomycin sclerotherapy.
Two patients presented to our institution with extensive lymphatic malformation of the neck, parapharyngeal, and retropharyngeal spaces, and two presented with venous malformation of the nasopharynx and oropharynx. All patients were treated with multiple sclerotherapy and debulking procedures before undergoing combined direct transmucosal puncture bleomycin sclerotherapy guided by direct laryngoscopy or nasopharyngoscopy. All patients had complete resolution of disease while maintaining a safe airway.
A multidisciplinary approach to airway vascular malformations with a combination of endoscopy and direct puncture bleomycin sclerotherapy was demonstrated to be a safe and effective treatment in our patient cohort. Direct laryngoscopy and nasopharyngoscopy provide easy access to the nasopharynx, oropharynx, retro- and/or parapharyngeal spaces and larynx. Unlike traditional agents, bleomycin induces minimal edema and therefore is an ideal substance to treat airway lesions.
目的/假设：描述一种多学科方法，用于治疗气道血管畸形（静脉或淋巴管型），采用直接悬吊硬质喉镜检查，并在路线图荧光透视监测下经黏膜直接穿刺注射博来霉素硬化治疗，辅以动态计算机断层扫描。
病例系列。
我们对4例气道内静脉畸形或淋巴管畸形患者的病历和影像学资料进行了回顾性分析。患者接受了直接悬吊喉镜检查或硬质鼻咽喉镜检查与图像引导下直接穿刺博来霉素硬化治疗相结合的治疗。
2例患者因颈部、咽旁和咽后间隙广泛淋巴管畸形前来我院就诊，2例患者因鼻咽部和口咽部静脉畸形前来就诊。所有患者在接受联合直接经黏膜穿刺博来霉素硬化治疗（在直接喉镜或鼻咽喉镜引导下）之前，均接受了多次硬化治疗和减容手术。所有患者疾病均完全缓解，同时保持了气道安全。
在内镜检查和直接穿刺博来霉素硬化治疗相结合的多学科方法治疗气道血管畸形，在我们的患者队列中被证明是一种安全有效的治疗方法。直接喉镜检查和鼻咽喉镜检查可方便地进入鼻咽部、口咽部、咽后和/或咽旁间隙以及喉部。与传统药物不同，博来霉素引起的水肿最小，因此是治疗气道病变的理想药物。
