Management of the Low-Flow Head and Neck Vascular Malformations in Children: the Sclerotherapy Protocol
Management of the Low-Flow Head and Neck Vascular Malformations in Children: the Sclerotherapy Protocol
复制标题
DOI：
10.1055/s-0033-1354585
复制
发表时间：
2014-02-01
影响因子：
1.8
通讯作者：
Liu, Kelvin
中科院分区：
文献类型：
--
作者：
Leung, Michael;Leung, Ling;Liu, Kelvin
目的图像引导下硬化治疗头颈部低血流血管畸形已成为首选的治疗方法。作者回顾了这种情况下的管理协议，并评估其临床outcomes.Methods2010年至2013年接受硬化治疗的头颈部低血流血管畸形的儿童进行了审查。所有患者均由多学科血管畸形诊所的儿科外科医生和介入放射科医生进行评估。术前进行超声检查和静脉造影增强磁共振成像。在气管插管全麻下，在超声和透视引导下进行硬化治疗。十四烷基硫酸钠（STS）泡沫或乙醇胺用于静脉畸形和多西环素用于淋巴管畸形作为原发性硬化剂，而98%的乙醇被保留作为辅助硬化剂在选定的情况下重复程序。围手术期给予地塞米松0.2 mg/kg，每日三次，以减少硬化治疗后肿胀，并单次静脉注射甘露醇0.5 g/kg，以尽量减少血栓栓塞并发症。术后，患者被送入重症监护室进行机械通气下深度镇静气道protection.ResultsOverall 13名儿童（8男5女），平均年龄为25个月（范围，2个月-11年）进行了共25届的图像引导分期硬化治疗。静脉畸形5例，淋巴管畸形8例。位置方面有8个颈部，一个舌，一个腮腺，一个嘴唇，一个面部和一个腭病变。6例患者有阻塞性气道症状。5例患者需要2 - 6次分期硬化治疗。无气道和血栓栓塞并发症。1例患者出血，另1例患者在淋巴管畸形硬化治疗后复发性肿胀，并通过抽吸治疗。所有患者的体积均显著缩小超过50%。结论硬化剂注射治疗儿童头颈部血管畸形是一种安全有效的治疗方法。常规的围手术期方案是必要的，以减少气道和血栓栓塞并发症。所有接受硬化治疗的患者均出现体积缩小和功能改善。
AimImage-guided sclerotherapy is becoming the preferred treatment for low-flow vascular malformations in head and neck region. The authors review the management protocol for this condition and evaluate its clinical outcomes.MethodsChildren with low-flow vascular malformations in head and neck region undergoing sclerotherapy from 2010 to 2013 were reviewed. All patients were assessed by pediatric surgeons and interventional radiologists in the multidisciplinary vascular anomalies clinic. Ultrasonography and intravenous contrast enhanced magnetic resonance imaging were performed preoperatively. Under general anesthesia with endotracheal intubation, sclerotherapy were performed with ultrasonographic and fluoroscopic guidance. Sodium tetradecryl sulfate (STS) foam or ethanolamine was used for venous malformation and doxycycline for lymphatic malformations as primary sclerosants, whereas 98% ethanol was reserved as an adjuvant sclerosant in selected cases of repeated procedures. Perioperative dexamethasone 0.2 mg/kg thrice daily was administered to decrease postsclerotherapy swelling and single dose intravenous mannitol 0.5 g/kg was given to minimize thromboembolic complications. Postoperatively, patients were admitted to intensive care unit for mechanical ventilation under deep sedation for airway protection.ResultsOverall 13 children (8 male and 5 female) with a mean age of 25 months (range, 2 mo-11 y) underwent a total of 25 sessions of image-guided staged sclerotherapy. There were five venous and eight lymphatic malformations. Location wise there were eight cervical, one lingual, one parotid, one lip, one facial, and one palatal lesions. Six patients had obstructive airway symptoms. Five patients required staged sclerotherapies from two to six sessions. There were no airway and thromboembolic complications. One patient had bleeding while another had recurrent swelling following sclerotherapy for lymphatic malformations and they were treated by aspiration. Significant size reductions of more than 50% volume were achieved in all patients. All patients with obstructive symptoms showed improvement.ConclusionSclerotherapy is a safe and effective treatment for head and neck vascular malformations in children. Routine perioperative protocol is essential to reduce airway and thromboembolic complications. Size reduction and functional improvement occurred in all patients undergoing sclerotherapy.