儿童先天性动静脉畸形的治疗  

Treatment of congenital arteriovenous malformation in children

作　　者：刘建平[1] 刘凤恩[1] 段训洪 苏强 刘潜[2] Liu Jianping;Liu Fengen;Duan Xunhong;Su Qiang;Liu Qian(Department of Vascular Surgery,First Affiliated Hospital,Gannan Medical University,Ganzhou 341000,China;Department of Pediatric Surgery,First Affiliated Hospital,Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一附属医院血管外科,赣州341000 [2]赣南医学院第一附属医院小儿外科,赣州341000

出　　处：《中华小儿外科杂志》2019年第1期10-14,共5页Chinese Journal of Pediatric Surgery

基　　金：江西省赣鄱英才“555工程”领军人才项目(赣才字[2012]1号);人力资源与社会保障部2011年度留学人员科技启动项目([2011]474号);江西省自然科学基金项目(2010GZY0016);江西省青年自然科学基金项目(20142BAB215026);江西省临床重点专科专项;赣南医学院高水平学科专项资助;江西省脉管异常性疾病研究中心(培育).

摘　　要：目的探讨先天性动静脉畸形(arteriovenous malformation,AVM)的临床特征及治疗方法。方法回顾性分析赣南医学院第一附属医院血管外科2013年1月至2016年8月治疗的8例先天性动静脉畸形患儿临床资料。8例中,男3例,女5例。依据病灶部位不同,头颈面部2例,四肢4例,躯干2例。头颈面部采用介入栓塞和硬化剂治疗,四肢根据患儿部位及分型,分别予以手术、介入栓塞、硬化治疗或综合治疗。结果8例患儿症状均获消失或者缓解。1例左侧桡动脉畸形患儿行分支栓塞术后,二期行畸形静脉泡沫硬化治疗,患儿搏动性肿块消失,但表面仍伴有静脉显露;2例耳廓动静脉畸形患儿栓塞后行静脉硬化治疗,症状明显改善;1例右侧腋动静脉畸形患儿行传统手术治疗后症状消失,随访2年,症状无复发;1例左侧锁骨下动静脉畸形患儿行单纯栓塞术后,症状消失;2例Parkes-Weber综合征患儿均伴有肢体的增粗、胀痛,经栓塞后症状好转,予以增高鞋调整治疗;1例左侧髂内动脉先天性静脉畸形患儿,予以动脉栓塞治疗后,肿块变小,予以两次畸形静脉硬化治疗,症状缓解,仍随访中,拟后期行手术切除。结论AVM病情复杂,其血流动力学改变影响邻近器官及组织所产生的病理生理改变,增加了治疗难度;个体化或多学科的综合治疗可获得较好的效果。Objective To explore the clinical characteristics and therapeutic options for congenital arteriovenous malformation (AVM). Methods Retrospective analysis was performed for the clinical data of 8 hospitalized AVM children from January 2013 to August 2016. Treatments were reviewed and evaluated. There were 3 boys and 5 girls. As classified by site, the lesions were faciocervical (n=2), extremities (n=4) and trunk (n=2). Faciocervical lesion was treated with embolism and sclerotherapy. Surgery, embolism, sclerotherapy or combined therapy were applied for lesion on extremities and other lesions. Results All of them achieved excellent outcomes with a complete clinical recovery. After branch embolism, one case of left radial arterial AVM received secondary sclerotherapy. Pulsating mass disappeared and surface venous exposure persisted;two cases of auricular AVM improved obviously after embolism plus sclerotherapy;one case of right axillary AVM was free of any symptom after routine surgery. There was no recurrence during a 2-year follow-up period;one case of left infra-axillary AVM was symptom-free after simple embolism;two cases of Parkes-Weber syndrome were accompanied by thickening and swelling pain of extremities. There was a relief after embolism. Elevator shoes were provided;one case of left internal iliac artery AVM had a shrinking lesion after arterial embolism. There was a relief after two sessions of sclerotherapy. Follow-up was going on and later surgical resection planned. Conclusions Due to a complex pathogenesis, hemodynamic changes cause numerous pathophysiological conditions and therapeutic challenges. Treatment should be based on the location and classification of congenital AVM. Personalized treatment and inter-departmental cooperation may improve the efficiency of therapy.

关 键 词：动静脉畸形 儿童 治疗 

分 类 号：R726.5[医药卫生—儿科]