Bourgouin Patrick, Thomas-Chaussé Frédéric, Gilbert Patrick, Giroux Marie-France, Périgny Sébastien, Guertin Louis, Dubois Josée, Soulez Gilles
Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada.
Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada.
J Vasc Interv Radiol. 2018 Jun;29(6):809-815. doi: 10.1016/j.jvir.2017.12.028. Epub 2018 Apr 6.
To evaluate the efficacy and safety of sclerotherapy with sodium tetradecyl sulfate (STS) and bleomycin for treatment of venous malformations (VMs) of the oropharyngeal region.
A retrospective study of 33 patients with 46 VMs of the buccal and pharyngolaryngeal cavity associated with impairment of eating, respiration, or elocution was performed. Individual lesions were divided based on their anterior or posterior location, using the base of the tongue as an anatomic landmark. Lesion size was estimated with the use of orthogonal measurements on magnetic resonance or ultrasound images before and after treatment to assess radiologic response. Sclerotherapy sessions were performed under ultrasound, fluoroscopic, and, if needed, endoscopic guidance. Clinical response was assessed with the use of the Manchester Orofacial Pain Disability Scale. Methods for airway management were also compiled.
Following sclerotherapy, average VM diameter was reduced by 31.4% (P < .0001) on a per-patient basis and by 30.8% (P < .0001) on a per-lesion basis. The Manchester score improved by an average of 37.0% (P = .013). Four patients reported a worsening of symptoms, and 11 patients experienced symptomatic recurrence. Complications include pneumonia (5 patients) and urgent placement of a post-procedure tracheostomy (4 patients). Patients with posterior malformations experienced more complications (emergency tracheostomies in 4 and pneumonias in 4).
Sclerotherapy using STS is an efficient treatment for venous malformations of the buccal and pharyngolaryngeal cavity but can lead to significant complication for posterior lesions. Careful assessment of the airway is needed before treatment, and prophylactic tracheotomy should be considered in patients with posterior lesions.
评估十四烷基硫酸钠（STS）联合博来霉素硬化治疗口咽区域静脉畸形（VMs）的疗效和安全性。
对33例患有46处颊部及咽喉部VMs且伴有进食、呼吸或言语障碍的患者进行回顾性研究。以舌根部作为解剖标志，根据病变的前后位置对单个病变进行划分。在治疗前后使用磁共振或超声图像上的正交测量来估计病变大小，以评估放射学反应。硬化治疗在超声、荧光镜引导下进行，必要时在内镜引导下进行。使用曼彻斯特口腔面部疼痛残疾量表评估临床反应。还汇总了气道管理方法。
硬化治疗后，每位患者的VM平均直径减少了31.4%（P <.0001），每个病变的VM平均直径减少了30.8%（P <.0001）。曼彻斯特评分平均提高了37.0%（P =.013）。有4例患者报告症状恶化，11例患者出现症状复发。并发症包括肺炎（5例患者）和术后紧急气管切开术（4例患者）。后部畸形患者出现更多并发症（4例紧急气管切开术和4例肺炎）。
使用STS进行硬化治疗是颊部及咽喉部静脉畸形的有效治疗方法，但可能导致后部病变出现严重并发症。治疗前需要仔细评估气道，对于后部病变患者应考虑预防性气管切开术。
