CAJ | 학술논문

目的探讨采用弹簧钢圈及无水乙醇栓塞治疗儿童先天性股深动静脉瘘的临床疗效及安全性.方法 8例先天性股深动静脉瘘的儿童均经B超及动脉造影检查证实为股深动静脉瘘,均接受介入治疗.术中将2.7F微导管插至瘘口处,注入弹簧钢圈或无水乙醇以堵塞瘘支,10 min后再次于股动脉处造影,如果仍然有残余瘘口,使用同样的方法继续堵塞瘘支直至瘘口完全闭塞.实施血管内介入栓塞治疗后4周行血管造影复查,若仍有残余瘘口则再次进行栓塞.随访6个月至2年,观察临床症状及体征改变.结果动脉造影可清楚地显示股深动脉及其分支以及瘘口情况,3例只见单一瘘口,5例合并多个微瘘口存在.8例患儿共实施介入栓塞术10次,释放弹簧钢圈共47枚,进行无水乙醇栓塞7次,技术操作均成功.无弹簧钢圈异位栓塞,未出现皮肤明显坏死、神经功能损害及心脑肺严重并发症,术中瘘口均立即闭塞.术后4周再次行血管造影复查,7例瘘口完全闭塞,临床症状较前改善,未见复发；1例可见股深动脉分支多发微小瘘口,先后共行3次介入栓塞术,仍见少许残余微瘘存在,但临床症状控制良好,无再发展.结论介入栓塞治疗儿童先天性股深动静脉瘘是一种安全、有效的方法,有望成为儿童先天性股深动静脉瘘的首选治疗方法.
목적 탐토채용탄황강권급무수을순전새치료인동선천성고심동정맥루적림상료효급안전성.방법 8례선천성고심동정맥루적인동균경B초급동맥조영검사증실위고심동정맥루,균접수개입치료.술중장2.7F미도관삽지루구처,주입탄황강권혹무수을순이도새루지,10 min후재차우고동맥처조영,여과잉연유잔여루구,사용동양적방법계속도새루지직지루구완전폐새.실시혈관내개입전새치료후4주행혈관조영복사,약잉유잔여루구칙재차진행전새.수방6개월지2년,관찰림상증상급체정개변.결과 동맥조영가청초지현시고심동맥급기분지이급루구정황,3례지견단일루구,5례합병다개미루구존재.8례환인공실시개입전새술10차,석방탄황강권공47매,진행무수을순전새7차,기술조작균성공.무탄황강권이위전새,미출현피부명현배사、신경공능손해급심뇌폐엄중병발증,술중루구균립즉폐새.술후4주재차행혈관조영복사,7례루구완전폐새,림상증상교전개선,미견복발；1례가견고심동맥분지다발미소루구,선후공행3차개입전새술,잉견소허잔여미루존재,단림상증상공제량호,무재발전.결론 개입전새치료인동선천성고심동정맥루시일충안전、유효적방법,유망성위인동선천성고심동정맥루적수선치료방법.
Objective To explore the effect and safty of interventional embolization of congenital arteriovenous fistula (CAVF) in the common femoral profounda artery in children.Methods Eight children (aged 6 to 14 years ;6 males and 2 females) with CAVF underwent interventional embolization From January 2006 and December 2010.Color Doppler sonography and DSA were performed on all patients.Arterial duplex imaging revealed the arteriovenous fistula in the common femoral profounda artery and DSA further confirmed the presence of an AVF over the common femoral profounda artery via the other vein.All children were treated with interventional embolization therapy by the injection ofcoils or ethanol through a microcather.It was necessary to performed repeated interventional embolization if the lesion was not obliterated in 4 weeks.All patients were followed-up from 6 months to 2 years and the clinical symptoms were observed.Results Arteriograpy can clearly demonstrate the femoral profounda artery and its branches as well as the fistula.Ten interventional embolization procedures were performed.Forty seven coils were deployedduring the procedure and seven ethanol embolization procedures were performed.Post-procedural angiography revealed complete occlusion in 8 patients.No major complications such as ectopic coil embolization,tissue necrosis,peripheral nerve palsy or cardio-pulmonary collapse were found.The abnormal AVFs were embolized completely in 7 cases after only one therapy and there was no recurrent disease in the 6 months to 2 years follow-up.Some tiny AVFs were still found in another case which underwent three additional treatments.However,the clinical symptoms were under control.Conclusion Interventional embolization is a safe and effective therapeutic method for CAVF of the common femoral profounda artery in children and it might become the primary treatment option.