MacArthur Carol J, Nesbit Gary
Department of Otolaryngology, Head & Neck Surgery, Oregon Heath & Science University, USA.
Department of Neuro-Interventional Radiology, Oregon Heath & Science University, USA.
Int J Pediatr Otorhinolaryngol. 2019 Mar;118:143-146. doi: 10.1016/j.ijporl.2018.12.017. Epub 2018 Dec 25.
To review simultaneous intra-operative sclerotherapy (IOS) with immediate surgical resection for the treatment of cervicofacial venous malformations (VMs) at a single institution. While pre-operative sclerotherapy (POS) has been reported in the literature, simultaneous intra-operative sclerotherapy and surgery in the operating room has not.
The database from the Hemangioma and Vascular Birthmarks Clinic was reviewed. All patients in both groups had biopsy-proven VMs.
IOS was used in 11 surgical patients with average age 17 years. Sclerotherapy was performed with sodium tetradecyl sulfate 3%, absolute alcohol or bleomycin. Immediately after IOS, and under the same anesthetic, all patients had either complete resection or debulking of the VMs. Eight patients had complete resolution of their VM and 3 had improvement. Average duration of the combined procedures done under a single anesthetic was 121 min. The POS approach was used for 6 surgical patients with average age 7 years. Sclerotherapy agents used were absolute alcohol or sodium tetradecyl sulfate 3%. All patients underwent complete resection of the VM 24-72 h after sclerotherapy under a separate surgical session. Five patients experienced complete resolution of their VM and one has had further sclerotherapy for recurrent disease. Interventional Radiology suite sclerotherapy times were on average 70 min. Surgical times were on average 142 min. Total combined anesthesia times for the two procedures added together were 212 min. Treatment time was significantly shorter in the IOS group (p = 0.0015).
Simultaneous IOS at the time of surgical resection has been successful in our hands. IOS has the advantage of a single procedure and decreased cost to the patient. In the era of reducing pediatric exposure to anesthesia, this approach is especially attractive in the pediatric population. As well, at approximately $100/minute cost to the patient to be in either the Interventional Radiology Suite or in the operating room, the reduced length of the procedures seen in the IOS approach results in lower overall cost to the patient.
回顾在单一机构中采用术中同步硬化治疗（IOS）联合即刻手术切除治疗头颈部静脉畸形（VMs）的情况。虽然术前硬化治疗（POS）在文献中有报道，但在手术室进行术中同步硬化治疗和手术的情况尚未见报道。
回顾血管瘤和血管胎记诊所的数据库。两组所有患者均经活检证实为VMs。
11例手术患者采用了IOS，平均年龄17岁。使用3%十四烷基硫酸钠、无水乙醇或博来霉素进行硬化治疗。IOS后即刻，在相同麻醉下，所有患者均对VMs进行了完整切除或减瘤手术。8例患者的VMs完全消退，3例有所改善。在单次麻醉下进行联合手术的平均时长为121分钟。6例手术患者采用了POS方法，平均年龄7岁。使用的硬化治疗药物为无水乙醇或3%十四烷基硫酸钠。所有患者在硬化治疗后24 - 72小时在单独的手术中接受了VMs的完整切除。5例患者的VMs完全消退，1例因疾病复发接受了进一步的硬化治疗。介入放射科的硬化治疗时间平均为70分钟。手术时间平均为142分钟。两种手术的总联合麻醉时间为212分钟。IOS组的治疗时间显著更短（p = 0.0015）。
在我们的实践中，手术切除时同步进行IOS已取得成功。IOS具有单次手术的优势，且降低了患者的费用。在减少儿科患者麻醉暴露的时代，这种方法在儿科人群中尤其具有吸引力。此外，患者在介入放射科或手术室的费用约为每分钟100美元，IOS方法中手术时长的缩短降低了患者的总体费用。
