運用經血管栓塞術配合保守性手術切除下顎骨中心型血管瘤：一病例報告

Treatment of Central Hemangioma of the Mandible via Transarterial Embolization and Conservative Excision with Minimal Hemorrhage: A Case Report

陳宜君(Chun-Yi Chen) ； 蔣維凡(Wei-Fan Chiang) ； 顏欽堉(Ching-Yu Yen) ； 劉巡宇(Shyun-Yeu Liu) ； 吳仁宏(Reng-Hong Wu) ； 周大雄(Ta-Hsiung Chou)

《中華民國口腔顎面外科學會雜誌》 16卷2期 (2005/09) Pp. 119-127

https://doi.org/10.7104/CJOMS.200509.0119

摘要

中心型血管瘤爲頭頸部腫瘤中罕見之病例，發生部位以下顎骨最常見。初期中心型血管瘤並無明顯的臨床表徵，少數病人會有疼痛、皮膚感覺異常、腫賬、牙齒動搖或局部牙齦出血之症狀。此病灶常因被忽略爲血管瘤，便進行牙科侵入性治療而導致大量出血，甚或造成死亡，端賴臨床醫師細心地依臨床症狀及影像學檢查來進行診治。爲避免術中發生無法控制之出血，以往中心型血管瘤之治療方法只能採用外頸動脈結紮術並配合大塊切除術(en bloc resection)避開病灶，以降低出血機率來進行治療。然而此傳統治療方式在術中仍無法完全避免大量出血的發生，且術後對病患之外觀、功能及生活品質均造成諸多影響。本文提出一例經診所醫師拔牙後引發大量出血之骨內血管瘤病例，爲減少術中出血量，於術前利用組織丙烯酸膠(histoacrylic glue)及線圈(coil)先行經血管栓塞術，再配合下顎骨邊緣切除術來切除血管瘤，此術式較傳統方式有效地減低術中出血的情況，並且保存了病患大部分之原先外觀。本文將探討此骨內血管瘤病例的治療方式，並與傳統的治療方式作一比較。

關鍵字

中心型血管瘤 ； 下顎骨 ； 經血管栓塞術

並列摘要

Central hemangioma is a rare benign tumor occurring often in vertebra and skull. The lesions can also present in the head and neck region with a predominance of the mandible. In the beginning of the tumor occurrence, the patient may suffer from pain, altered nerve sensation, swelling, mobile tooth, accelerated exfoliation of the tooth, oozing or pulsatile bleeding from the gingiva around the teeth in the region of the lesion. The real importance of hemangioma lies in the potential to lead to lethal bleeding. Patients might be dead because of active bleeding resulting from invasive surgical intervention since unawareness of the nature of the lesion. Treatment of theses lesion usually present a challenge due to the risk of excessive bleeding. The previous mode of treating central hemangioma was performing surgical ligation of either ipsilateral or bilateral external carotid artery, and then the lesions could be removed by en-bloc resection with safe margin. But the surgeons still faced the possibility of fetal bleeding during operation. By the way, many complications could be associated with en-bloc resection including change of the appearance, impairment of function, and the inconvenience of life quality. We report a case of central hemangioma of mandible presenting with massive bleeding after extraction of the tooth in the region of the lesion. This case was sussccesfully treated by transarterial embolization (TAE) with histoacrylic glue and coil to reduce the amount of bleeding during the operation of marginal mandibulectomy.

並列關鍵字

Central hemangioma ； mandible ； transarterial embolization