摘要
目的评价行经导管动脉硬化栓塞(TASE)联合局部注射硬化(IS)治疗婴儿颌面部巨大血管瘤的疗效及安全性,并与单纯动脉硬化栓塞治疗比较。方法收治32例婴儿颌面部巨大血管瘤病例,行经股动脉插管血管瘤硬化栓塞治疗。血管瘤供血动脉插管,依次使用碘油博莱霉素乳剂及聚乙烯醇泡沫颗粒栓塞。术后2周对残余病灶行博莱霉素局部IS治疗。对照组25例仅行单纯动脉硬化栓塞治疗。结果 32例共行TASE术35次,其中3例行2次。32例术后共行博莱霉素IS治疗112次,每例行3～5次,平均3.5次。32例中达治愈标准25例(78.1%),达显效标准7例(21.9%),无效0例,显效率100%,治疗结束后平均随访13个月(6～16个月),无复发病例。单纯TASE组25例共行TASE术35次,每例行1～3次,平均1.4次。其中达治愈标准19例(76.0%),达显效标准6例(24.0%)。TASE+IS组治疗次数较单纯TASE组明显减少,差异有统计学意义(P=0.0205)。两组间治疗效果差异无统计学意义(P=0.8495)。本组未出现肺栓塞、脑栓塞等严重并发症。结论婴儿巨大血管瘤经导管动脉硬化栓塞治疗联合局部IS治疗具有创伤小、安全、疗效显著、大多数病例术后不留瘢痕等优点,可较单纯经导管动脉硬化栓塞治疗减少手术次数。
Objective Infantile hemangiomas frequently occur in the maxillofacial region as an extensive mass involving many vital structures.For this reason,many infants are found to have an unresectable hemangioma even at the initial diagnosis.In the present study simple transcatheter arterial sclerosing embolization（TASE） by using bleomycin-lipiodol and polyvinyl alcohol emulsion as embolization agents or the combination use of TASE with local injection of bleomycin-lipiodol has been employed with an attempt to improve the therapeutic results of these lesions.In this paper the clinical effectiveness and the technical safety of the two procedures for the huge maxillofacial hemangiomas in infants are presented and discussed.Methods A total of fifty-seven infants with huge maxillofacial hemangiomas were enrolled in this study.Selective TASE followed by percutaneous injection sclerotherapy（IS） was adopted in 32 consecutive cases（study group）.During TASE the feeding arteries of the lesion were embolized with pingyangmycin-lipiodol emulsion（PLE） and polyvinyl alcohol（PVA） particles in turn.Two weeks after TASE the residual hemangiomas were treated by percutaneous injection of pingyangmycin-lipiodol emulsion.Simple selective TASE was employed in another 25 cases（control group）.The clinical data were analyzed and the results were compared between the two groups.Results All the infants showed an excellent response to both TASE or TASE together with IS treatment.The size of hemangiomas body markedly decreased after the treatment.In 32 cases of the study group,a total of thirty-five times of TASE procedure were conducted with a mean of 1.1 times per case,while a total of 112 times of IS procedure were performed with a mean of 3.5 times per case.The curative rate was 78.1%（25/32）,obvious effective rate was 21.9%（7/32） and ineffective rate was 0% in study group.The patients were followed up for a mean period of 13 months（6-16 months） and no recurrence was seen.A total of thirty-five times of simple TASE procedure were carried out in 25 cases of control group with a mean of 1.4 times per case.The curative rate and obvious effective rate were 76.0%（19/25） and 24.0%（6/25）,respectively.The number of procedure times in study group was much smaller than that in control group,the difference between the two groups was statistically significant（P = 0.0205）.No significant difference in therapeutic effectiveness existed between the two groups（P = 0.8495）.No serious complications,such as pulmonary infarction or cerebral infarction,occurred in this series.Conclusion As a mini-invasive,safe and effective technique,transcatheter arterial sclerosing embolization together with percutaneous injection sclerotherapy should be regarded as the treatment of first choice for huge maxillofacial hemangiomas in infants.This therapy carries fewer complications and leaves no ugly scar,and can also shorten the hospitalization days.
出处
《介入放射学杂志》
CSCD
北大核心
2011年第11期848-852,共5页
Journal of Interventional Radiology
基金
广州市医药卫生基金资助(2006-YB-220)
关键词
血管瘤
栓塞
治疗性
聚乙烯乙醇
博莱霉素碘油乳剂
hemangioma
interventional embolization
therapeutic
polyvinyl alcohol
bleomycin-lipiodol emulsion
