头颈部微动脉畸形的诊断和治疗：48例临床总结

doi:10.19438/j.cjoms.2025.06.011

摘要/Abstract

摘要： 目的：头颈部淡红色斑常被误诊为毛细血管畸形而行激光治疗,却疗效不佳。增强 CT 和 MRI 检查无明显异常,但多普勒超声可闻及增强动脉杂音,血管造影显示病灶处密集微动脉分布。本研究旨在对此类隐匿性血管畸形进行命名、分类,并总结其诊断与治疗方法。方法：回顾分析2012年4月至2021年10月北京大学口腔医院收治的48例头颈部微动脉畸形患者的临床资料,归纳其症状、体征及辅助检查结果,总结经皮穿刺微动脉栓塞治疗、血管灌注治疗、手术治疗及硬化治疗等方法的应用效果。结果：微动脉畸形根据发病部位可分为皮肤型和黏膜型;根据供养血管特点可分为中央型（Ⅰ型）和发散型（Ⅱ型）。皮肤型微动脉畸形临床表现为皮肤淡红色斑,偶有自发性出血,皮温轻度增高或正常;黏膜型呈丘状隆起,中央微凹伴出血。多普勒超声可闻及异常动脉杂音,血管造影显示密集微动脉,而CT/MRI 多为阴性结果。治疗以经皮穿刺微动脉栓塞为主,辅助灌注治疗、硬化治疗或手术切除。随访5年显示,自发性出血和红斑消退,异常动脉音消失,并发症包括水肿、溃疡、复发等,总体疗效显著。结论：部分淡红色斑是隐匿性微动脉畸形,易与毛细血管畸形混淆,多普勒超声是重要鉴别手段。根据分型选择个体化治疗方案（如栓塞联合灌注）可有效控制病情,减少误诊误治。

关键词: 微动脉畸形, 血管畸形, 血管栓塞治疗, 血管灌注治疗, 硬化治疗

Abstract: PURPOSE: Reddish erythemas in the head and neck region are often misdiagnosed as capillary malformations and treated with laser therapy, but the efficacy is poor. Enhanced CT and MRI examinations usually show no obvious abnormalities, while ultrasonic Doppler can detect enhanced arterial murmurs, and angiography reveals dense distribution of arterioles in the lesion. This study aimed to name and classify such occult vascular malformations, and summarize their diagnostic and treatment methods. METHODS: The clinical data of 48 patients with arteriole malformations in the head and neck admitted to Peking University School and Hospital of Stomatology from April 2012 to October 2021 were retrospectively analyzed. Their symptoms, signs, and auxiliary examination results were summarized, and the application effects of percutaneous puncture arteriolar embolization, vascular perfusion therapy, surgical treatment, and sclerotherapy were evaluated. RESULTS: Arteriole malformations could be classified into cutaneous type and mucosal type based on the location of onset, and into central type(type Ⅰ) and divergent type(type Ⅱ) based on the characteristics of the supplying vessels. The clinical manifestations of cutaneous arteriolar malformations were reddish erythemas on the skin, occasional spontaneous bleeding, and slightly increased or normal skin temperature; the mucosal type presented as papillary elevation with central micro-depression accompanied by bleeding. Abnormal arterial murmurs could be heard by ultrasonic Doppler, angiography showed dense arterioles, while CT/MRI were mostly negative. The treatment was mainly percutaneous puncture arteriolar embolization, assisted by perfusion, sclerotherapy or surgical resection. A 5-year follow-up showed that spontaneous bleeding and erythema subsided, abnormal arterial sounds disappeared, and complications included edema, ulcer, recurrence, etc., with significant overall good efficacy. CONCLUSIONS: Some reddish erythemas are occult arteriole malformations, easily confused with capillary malformations. Ultrasonic Doppler is an important differential tool. Individualized treatment regimens (such as embolization combined with perfusion) selected according to typing can effectively control the condition and reduce misdiagnosis and mistreatment.

Key words: Arteriole malformation, Vascular malformation, Vascular embolization, Vascular perfusion, Sclerotherapy

中图分类号:

R782.2

骆泉丰. 头颈部微动脉畸形的诊断和治疗：48例临床总结[J]. 中国口腔颌面外科杂志, 2025, 23(6): 608-612.

Luo Quanfeng. Diagnosis and treatment of arteriole malformation in head and neck: a clinical summary of 48 cases[J]. China J Oral Maxillofac Surg, 2025, 23(6): 608-612.

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