巨大唇部动静脉畸形综合治疗9例临床报告
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[摘要] 目的:总结应用综合方法治疗巨大唇部动静脉畸形的治疗经验体会。方法:2002年5月~2009年10月治疗上唇部巨大动静脉畸形9例,男7例,女2例,年龄28~42岁,病变范围占上唇部的80%以上。采用双侧上唇动脉结扎术,术后第3天即行上唇部2~3点点状注射鱼肝油酸钠。2周后全上唇部多点注射,每次注射总量不超过4 ml。每2周注射1次,注射5~7次,待全唇无明显压缩感后,行唇部成形术。结果:随访1~7年,8例唇部形态正常,外形满意,瘤体无复发,1例局部复发,经硬化剂注射后,瘤腔消失,形态恢复正常。结论:巨大唇部动静脉畸形选择循序渐进的综合治疗方法,可达到较为理想的治疗效果。
[关键词] 唇;动静脉畸形;硬化注射;综合治疗
[中图分类号] R781.5+6 [文献标识码] A [文章编号] 1674-4721(2011)11(c)-025-02
Clinical report on the treatment of 9 cases of huge lip arteriovenous malformation with integrate approach
HE Guoquan, XIONG Lei, TANG Yi, DAI Dehua
Stomatology Department of Jingzhou Central Hospital, Hubei Province, Jingzhou 434020, China
[Abstract] Objective: To summarize the experiences in treating huge lip arteriovenous malformation with integrate approach. Methods: Nine cases of huge lip arteriovenous malformation were treated from May 2002 to October 2009. 7 patients were male and 2 patients were female, aged 28-42 years whose extent of disease accounts for more than 80% of their upper lip. All cases were performed bilateral upper lip artery ligation. Two days after the surgery, point injection (2-3 points) of sodium morrhuate was implemented in roots of the upper lips. Two weeks later, other parts of the upper lips should also be injected sodium morrhuate with maximum of 4 ml. After that, the lip should be injected once two weeks, which lasts 5 to 7. Lip plasty should be implemented after the sense of compression disappears. Results: After 1-7 years follow-up, it was found that the lip forms of 8 cases were normal and satisfactory. Only one case had a local recurrence, and the form was restored after sclerotherapy. Conclusion: The treatment of huge lip arteriovenous malformation with integrate approach can achieve a ideal therapeutic effect.
[Key words] Lip; Arteriovenous malformation; Sclerotherapy; Comprehensive treatment
动静、脉畸形是脉管畸形的一种临床表现,是从异常的前毛细血管括约肌畸形发展而来[1],临床表现较晚,皮肤表面可见扩张、扭曲的动脉和静脉,可扪及震颤感,破溃后出血凶猛,临床治疗较为棘手。本科2002年5月~2009年10月共收治9例巨大唇部动、静脉畸形患者,均采用循序渐进的综合治疗,取得满意效果,报道如下:
1 资料与方法
1.1 一般资料
9例上唇部动、静脉畸形患者中,男7例,女2例,年龄28~42岁,波及全上唇者6例,波及2/3上唇者2例,波及1/2上唇者1例。所有患者均在10岁以后发现,病程最长30年。唇部最厚达3.5 cm (图1)。
1.2 治疗方法
采用循序渐进的治疗方法,即先行双侧或一侧上唇动脉结扎,结扎后第3天行上唇根部瘤腔内鱼肝油酸钠2~3点点状注射,每点注射部位不超过1 ml,每次注射总量不超过4 ml。以后每2周注射1次,注射时选择有明显压缩感的部位。注射完成的标志是整个唇部无压缩感。注射完成后3个月复查,如注射部位无明显复发即可行唇部成形手术。手术设计如图1所示,白唇、红唇交界处为标志,按正常红唇高度画线,标示出应切除的多余部分。切除多余组织后,从鼻根部正中往下严密缝合,将多余的组织移向唇两侧。唇两侧口角部切除多余的组织,切除的量以上、下唇关系协调、外形接近正常为准。唇部成形完成后,唇内、外侧用消毒预制的聚乙稀塑料夹板(唇内、外各置一块),唇部全层贯穿加压缝扎,加压的力度为唇部厚度接近正常,红唇部色泽正常(图2)。术后3 d拆除塑料夹板。术后7 d拆除缝线。
图2 塑料夹板贯穿缝扎
2 结果
经1~7年以上随访, 8例患者外形满意,皮肤颜色3个月后逐渐变浅,接近于正常肤色,瘤体无复发。1例半年后局部复发,有压缩感,范围约1 cm2,经硬化剂注射后,瘤腔消失,形态恢复正常。
3 讨论
动、静脉畸形按以前为蔓状血管瘤。皮肤表面可见扩张、扭曲的动脉和静脉,触诊较静脉畸形坚硬,压缩后可迅速恢复,有震颤感,皮肤温度增高,循环血量增加。皮肤、黏膜变薄,甚至坏死出血[2]。9例患者中有4例曾发生皮肤黏膜破溃,喷射状出血,曾在当地行压迫、缝扎止血,出血量最多可达200~400 ml,可见出血凶猛。
动、静脉畸形出生时病变就可能存在,但临床表现较晚,可以在青春期或成年发现。不少患者以大出血急诊住院才被确诊,有学者根据病变发展进程将其分为四型:静止期、扩展期、破坏期和畸形期。其中静止期病程较长,皮肤呈蓝紫色,温度较高。破坏期可出现疼痛、溃疡、出血、感染[3] ......
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