组织工程与重建外科杂志 ›› 2024, Vol. 20 ›› Issue (6): 617-.

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体表动静脉畸形病灶血管构筑的临床研究:术前评估与治疗策略

  

  • 出版日期:2024-12-02 发布日期:2025-01-03

Vascular construction of arteriovenous malformation lesions on the body surface Preoperative evaluation and treatment strategies

  • Online:2024-12-02 Published:2025-01-03

摘要:

目的 探讨一种精准有效的体表动静脉畸形(Arteriovenous malformation,AVM)血管构筑的检查方法,指导术前评估和治疗方案的选择。方法 自2022年9月至2024年9月,共67例体表AVM患者纳入研究。治疗前进行CT血管成像(CTA)检查,应用 Philips CT 6000螺旋 CT 机扫描,PHILIPS IntelliSpace Portal 工作站进行图像后处理,进行最大密度投影(MIP)、表面遮盖方法重(SSD),再结合原始图像观察,根据血管构筑情况选择相应的治疗方案。结果 67例体表 AVM 患者 CTA图像均可显示异常的病变血管及其与周围组织的解剖关系,以及邻近骨质的情况。根据 Yakes分型标准,将其进行分型:6例患者表现为Yakes Ⅰ型;28例表现为Yakes Ⅱa型;4例患者表现为Yakes Ⅱb型;4例表现为Yakes Ⅲa型;10例表现为Yakes Ⅲb型;11例表现为Yakes Ⅳ型;4例患者无法归入某种特定类型。根据患者的CTA图像显示的病变区的血管构筑特征,设计相应的治疗方案,治疗方法包括间质注射治疗4例、外科手术治疗16例、无水乙醇介入治疗36例、联合治疗11例。结论 CTA检查可以获得体表AVM病灶精准清晰的血管构筑图像,对术前评估和
选择治疗方案具有重要的临床指导意义。

关键词:

Abstract:

Objective To explore an accurate and effective examination method for arteriovenous malformation (AVM)vascular construction on the body surface, in order to guide the preoperative evaluation and the selection of treatment.Methods From September 2022 to September 2024, a total of 67 patients with body surface AVM were enrolled. Computed tomography angiography (CTA) was performed before treatment, Philips CT 6000 spiral CT was used for scanning, PHILIPS IntelliSpace Portal workstation was used for image post-processing, maximum density projection (MIP) and surface masking method reconstruction (SSD) were performed. Combined with the original image observation, the corresponding treatment plan was selected according to the vascular construction. Results CTA images of 67 patients with surface AVM showed abnormal blood vessels and their anatomical relationship with surrounding tissues, as well as the condition of adjacent bones. The patients were classified according to the Yakes classification criteria:6 patients showed Yakes type Ⅰ;28 cases showed Yakes type Ⅱa;4 patients showed Yakes type Ⅱb;4 patients showed Yakes type Ⅲa;10 cases showed Yakes type Ⅲb;11 patients showed Yakes type Ⅳ ;4 patients could not be classified into a particular category. Based on the vascular architecture characteristics of the lesion area shown by the patient's CTA images, the corresponding treatment plan was designed, including interstitial injection therapy in 4 cases, surgical treatment in 16 cases, interventional treatment with absolute ethanol in 36 cases and combination therapy in 11 cases. Conclusion CTA examination can obtain accurate and  clear vascular images of AVM lesions on the body surface, which has important clinical guiding significance for preoperative evaluation and treatment plan design

Key words:

Absolute ethanol