经导管动脉硬化栓塞联合普萘洛尔治疗婴幼儿颌面部巨大血管瘤

摘要

Objective To discuss the therapeutic effect of transcatheter arterial embolization using hardening agent combined with oral propranolol in treating giant hemangioma at maxillofacial region in infants. Methods During the period from October 2013 to December 2014 at Imaging Center of Anhui Provincial Children's Hospital, transcatheter arterial embolization using hardening agent combined with oral propranolol was employed in a total of 27 infants with giant hemangioma at maxillofacial region. The age of the infants ranged from 2 months to 22 months (mean 5.9 months) and the body weight was 4.5-10 kg with a mean of 6.32 kg. Angiography via femoral artery was performed, which was followed by super-selective catheterization of hemangioma-feeding artery, and then pingyangmycin lipiodol emulsion was injected into the hemangiomas with subsequent injection of PVA particles to obstruct the hemangioma-feeding artery. After the embolization treatment, the patient received oral propranolol for 3-6 months. Results All the infant patients were followed up for 3-6 months. Clinical examination and ultrasonography indicated that the hemangioma was cured in 20 infants (75%) and the therapeutic result was effective in 7 infants (25%). Skin necrosis at hemangiomas site was observed in 2 infants (7.5%), which was cured after symptomatic treatment. No serious complications such as pulmonary embolism, cerebral embolism occurred, and no recurrence was observed. Conclusion For the treatment of giant hemangioma at maxillofacial region in infants, transcatheter arterial embolization using hardening agent combined with oral propranolol is minimally invasive, quickly effective and highly safe;and this treatment leaves no scar formation in most cases. Therefore, this technique is worthy of clinical application.%目的：总结经导管动脉硬化栓塞术（TASE）联合普萘洛尔治疗婴幼儿颌面部巨大血管瘤的效果。方法2013年10月至2014年12月安徽省儿童医院影像中心采用TASE联合普萘洛尔治疗27例颌面部巨大血管瘤患儿（年龄2~22个月,平均5.9个月；体重4.5~10 kg,平均6.32 kg）。 TASE术中行股动脉插管造影,血管瘤供血动脉超选择插管造影证实后向瘤体内注入平阳霉素碘油乳剂,再用聚乙烯醇（PVA）颗粒栓塞瘤体供血动脉。术后口服普萘洛尔3~6个月。结果所有患儿随访3~6个月,临床体检和超声检查显示20例（75%）达治愈标准,7例（25%）显效。2例（7.5%）瘤体表面皮肤出现坏死,经对症处理后好转。未出现肺栓塞、脑栓塞等严重并发症,无复发病例。结论 TASE联合普萘洛尔治疗婴幼儿颌面部巨大血管瘤具有创伤小、见效快、安全性高、大多无瘢痕等优点,值得临床推广应用。