无水乙醇硬化治疗联合气管切开术对累及气道的头颈部静脉畸形的疗效  

Effect of absolute ethanol sclerotherapy combined with tracheotomy for treatment of head and neck venous malformations involving airway

作　　者：温明哲 杨西涛[1] 王德明[1] 苏立新[1] 范新东[1] Wen Mingzhe;Yang Xitao;Wang Deming;Su Lixin;Fan Xindong(Department of Intervention,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院介入科,上海200011

出　　处：《血管与腔内血管外科杂志》2021年第11期1314-1318,1328,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨无水乙醇硬化治疗联合气管切开术对累及气道的头颈部静脉畸形的治疗效果,总结该类复杂疾病的治疗经验.方法 收集2016年6月至2019年10月上海交通大学医学院附属第九人民医院收治的24例累及气道的头颈部静脉畸形患者的临床资料,对患者于气管切开后行无水乙醇硬化治疗.分析无水乙醇硬化治疗联合气管切开术对累及气道的头颈部静脉畸形的疗效,并统计并发症发生情况.结果 24例患者共进行了68次无水乙醇硬化治疗,单次无水乙醇使用量为10~40 ml.术后,所有患者均出现严重局灶性肿胀,2周内消退.治疗后,磁共振成像(MRI)检查结果显示,6例患者完全反应,8例患者明显反应,10例患者中度反应.所有患者的临床症状和体征均得到完全缓解或部分缓解.24例患者中,3例患者术后出现局部黏膜坏死,经创面换药后愈合;3例患者术后出现面神经瘫痪,经1~3个月皮质类固醇及神经营养药物保守治疗后恢复;6例患者出现严重恶心、呕吐,经静脉输液治疗后症状消失.有12例患者共18次出现短暂的血红蛋白尿,经静脉注射碳酸氢钠和平衡液后5~6 h,血红蛋白尿消失.随访期间,所有患者均未发现因血红蛋白尿引起的肾功能损害,均未出现严重并发症.结论 无水乙醇硬化治疗联合气管切开术对于累及气道的头颈部静脉畸形是一种安全、有效的治疗方法.Objective To investigate the therapeutic effect of absolute ethanol sclerotherapy combined with tracheotomy on head and neck venous shape involved airway,and summarize the treatment experience of this kind of complex diseases.Method The clinical data of 24 patients with head and neck venous malformations involving airway treated in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from June 2016 to October 2019 were collected.The patients were treated with absolute ethanol sclerotherapy after tracheotomy.The effect of absolute ethanol sclerotherapy combined with tracheotomy on head and neck venous malformations involving airway were analyzed,and the complications were counted.Result A total of 68 times of absolute ethanol sclerotherapy were performed in 24 patients,and the single use dosage of absolute ethanol was 10-40 ml.After operation,all patients had severe focal swelling and subsided within 2 weeks.After treatment,magnetic resonance imaging(MRI)showed that 6 patients had a complete response,8 patients had a significant response,and 10 patients had a moderate response.All patients'clinical symptoms and signs were completely or partially alleviated.Among the 24 patients,3 patients had local mucosal necrosis after operation and healed after dressing change;3 patients developed facial nerve paralysis after operation and recovered after 1-3 months of conservative treatment with corticosteroids and neurotrophic drugs.Severe nausea and vomiting occurred in 6 patients,and the symptoms disappeared after intravenous infusion.Transient hemoglobinuria occurred 18 times in 12 patients.Hemoglobinuria disappeared 5-6 hours after intravenous injection of sodium bicarbonate and balance solution.During the follow-up,no renal function damage caused by hemoglobinuria was found in all patients,and no serious complications occurred.Conclusion Absolute ethanol sclerotherapy combined with tracheotomy is a safe and effective method for the treatment of head and neck venous malformations involving air

关 键 词：无水乙醇 静脉畸形 气管切开 硬化治疗 并发症 

分 类 号：R543[医药卫生—心血管疾病]