中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2024, Vol. 22 ›› Issue (1): 78-83.doi: 10.19438/j.cjoms.2024.01.014

• 综述 • 上一篇    下一篇

颌骨骨内动静脉畸形介入栓塞治疗远期疗效分析

李晓1, 王豪伟1, 杨西涛2, 王德明2, 范新东2,*, 苏立新2,*   

  1. 1.上海交通大学医学院附属第九人民医院 口腔第二门诊部,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011;
    2.上海交通大学医学院附属第九人民医院 介入科,上海 200011
  • 收稿日期:2023-01-15 修回日期:2023-09-11 出版日期:2024-01-20 发布日期:2024-02-05
  • 通讯作者: 苏立新,E-mail: sulixin1975@126.com;范新东,E-mail: fanxindong@aliyun.com。*共同通信作者
  • 基金资助:
    上海交通大学医学院附属第九人民医院基础研究助推计划（JYZZ225）

Long term efficacy analysis of interventional embolization treatment for intraosseous arteriovenous malformations of the jaw

LI Xiao1, WANG Hao-wei1, YANG Xi-tao2, WANG De-ming2, FAN Xin-dong2, SU Li-xin2   

  1. 1. The 2nd Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011;
    2. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2023-01-15 Revised:2023-09-11 Online:2024-01-20 Published:2024-02-05

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摘要： 目的: 探讨通过介入栓塞方式治疗颌骨骨内动静脉畸形的有效性和安全性。方法: 回顾分析就诊于上海交通大学医学院附属第九人民医院的颌骨骨内动静脉畸形患者9例,在DSA引导下予以介入栓塞治疗,通过DSA观察病变范围、预测硬化剂注射剂量以使药物注射入病变腔内,并对患者疗效、不良反应和并发症进行长期随访观察。结果: 9例患者中,男6例（66.7%）,女3例（33.3%）;年龄7~51岁,平均21.3岁。出血是患者最主要的报告症状（6例,66.7%）;供血动脉包括下牙槽动脉、面动脉以及上颌动脉分支。9例患者均于全麻下接受介入栓塞治疗,共治疗20次（每例患者接受1~5次,平均2.2次/例）。无水乙醇单次平均用量为21.95 mL。20次介入栓塞治疗中,9次应用弹簧圈辅助无水乙醇栓塞治疗,共使用158枚弹簧圈,平均17.6枚/次（80枚/9次）。另有2次使用博来霉素,5次使用少量150 μm PVA颗粒辅助栓塞治疗。9例患者随访时间5~11年,其中,4例治愈,3例基本治愈,2例好转,治疗有效率为100%。结论: 在颌骨骨内动静脉畸形治疗中,根据临床及影像学表现正确诊断、根据DSA造影结果采用以无水乙醇为主介入栓塞方案,可减少创伤、改善症状、控制病灶,获得相对满意的治疗效果,该方案安全、有效。

关键词: 颌骨, 动静脉畸形, 介入栓塞治疗, 弹簧圈, 无水乙醇

Abstract: PURPOSE: To explore the effectiveness and safety of interventional embolization for the treatment of intraosseous arteriovenous malformations (AVMs) in the jaw. METHODS: A retrospective study was conducted to analyze a total of 9 patients with intraosseous AVMs in the jaw bone who were treated at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Under the guidance of DSA, interventional embolization was performed to observe the lesion and predict the injection dose of sclerosing agents. The efficacy, adverse reactions and complications of patients were observed in a long-term follow-up. RESULTS: This study included 9 patients with intraosseous AVMs in the jaw, including 6 male patients (66.7%) and 3 female patients(33.3%), aged 7-51 years, with an average age of 21.3 years. Bleeding was the main reported symptom of patients, accounting for 66.7% of all cases. The blood supply arteries involved in this study included the branches of the inferior alveolar artery, facial artery, and maxillary artery. Nine cases of jaw bone AVMs were treated with interventional embolization under general anesthesia for a total of 20 times (each patient received 1-5 times, with an average of 2.2 times per person). The average single application dose of absolute ethanol was 21.95 mL. Among the 20 interventional embolization treatments, 9 were treated with coil assisted ethanol embolization, with a total of 158 coils used, with an average of 17.6 coils per treatment(80 coils per 9 treatments). Another 2 used bleomycin and 5 used a small amount of 150 μm PVA particles as auxiliary embolization therapy. Among the 9 cases of jaw bone AVMs included in this study, 4 were cured, 3 were basically cured, and 2 had improvement. The effective rate of treatment was 100%. CONCLUSIONS: In the treatment of intraosseous AVMs of the jaw, correct diagnosis based on clinical and imaging manifestations, and the use of ethanol embolization based on DSA imaging results can reduce trauma, improve symptoms, control lesions, and achieve relatively satisfactory treatment results. This treatment plan is safe and effective.

Key words: Jaw bone, Arteriovenous malformations, Interventional embolization therapy, Coil, Absolute ethanol

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