Airway Low Flow Vascular Malformations - Case Series and Literature Review

呼吸道低流速血管畸型－個案系列報告及文獻回顧

廖偉捷(Wei-Chieh Liao) ； 陳明庭(Ming-Ting Chen) ； 李建智(Jian-Jr Lee)

《臺灣整形外科醫學會雜誌》 27卷3期 (2018/09) Pp. 171-179

摘要

Background: Congenital vascular malformations are lesions of abnormal vascular development that grow proportionately with the patient’s body growth and do not regress spontaneously. Vascular malformations may rarely develop in the airway, and may cause hoarseness, bleeding, stridor, difficulty breathing, and even airway obstruction. Treatment for airway vascular malformations consists of surgery, laser therapy, and sclerotherapy. Aim and Objectives: Our treatment of airway vascular malformations includes direct puncture with transmucosal sodium tetradecyl sulfate injection and excision. Here, we aim to discuss the result of airway low flow vascular malformation patients treated with sodium tetradecyl sulfate injection. Materials and Methods: We present 9 patients with venous or lymphatic airway vascular malformations involving the tongue, soft palate, oropharynx, and larynx. Patients were treated with sclerotherapy, sclerotherapy combined with surgical removal, and surgical removal alone. We consulted anesthesiologist prior to treatment. All patients received endotracheal intubation during surgery, and 1 patient with an extensive pharyngeal-laryngeal airway vascular malformation received tracheostomy to ensure the airway. Results: Three patients presented to our hospital with extensive venous malformations in the pharyngeal and laryngeal airway and 4 presented with venous malformations in the oral cavity. These 7 patients received multiple sclerosant injections and had symptomatic improvement. Two patients presented with localized lymphatic malformations of the tongue and underwent surgical removal. Safe airway was maintained in all patients. Conclusions: Airway low flow vascular malformations can be effectively treated with sclerotherapy, which is safe, effective, and easy. Pre-sclerotherapy anesthesiological preparation is essential to ensure a safe airway.

關鍵字

airway vascular malformation ； sclerotherapy

並列摘要

背景：血管畸型是先天性的血管異常生長，在患者身上會隨著身體的成長而逐漸變大不會自然地消退。長在呼吸道的血管畸型是比較罕見的情況，但會造成呼吸道的流血、喉嚨沙啞、喘鳴以及呼吸道阻塞呼吸困難等。治療方法包含手術切除、雷射以及硬化劑治療。目的及目標：我們醫院治療呼吸道低流速血管畸型的方式是直接對於血管畸型的硬化劑注射以及視情況進行切除。本研究的目的是探討以硬化劑進行血管畸形注射，治療九例呼吸道低流速血管畸形的效果。材料及方法：我們回顧2004年至2017年有九位呼吸道低流速血管畸型的患者，呼吸道低流速血管畸型包含了靜脈血管畸型及淋巴管畸形，病灶所發生的位置包含了舌頭、軟顎、口咽以及喉咽等。我們治療病人的方式包含硬化劑注射、先進行硬化劑注射再切除以及直接切除。所有患者在治療之前均有會診麻醉科，手術以全身麻醉插管進行，其中一位患者由於喉咽血管畸型範圍及大小過大壓迫呼吸道，我們先幫他執行氣管造廔口手術已保護呼吸道再進行硬化劑注射手術。結果：九位患者當中三位患者有口咽部及喉咽部廣泛的低流速血管畸型，四位患者在口腔當中有血管畸型。上述提到的患者接受數次硬化劑注射之後均獲得症狀的改善。兩位患者有舌頭的血管畸型，並且接受血管畸型切除手術。所有病人均維持安全的呼吸道無壓迫的情形。結論：呼吸道低流速血管畸型可以有效且安全地使用硬化劑做治療，若要進行切除，術前的硬化劑準備是安全的要素。