IR@PKUHSC  > 北京大学第一临床医学院
学科主题耳鼻咽喉科学
低温等离子射频消融术治疗咽喉部血管瘤和血管畸形
白静
2016-10-26
导师肖水芳
专业耳鼻咽喉科学
授予单位北京大学
授予地点北京大学第一临床医学院
学位硕士
关键词低温等离子射频消融术 血管瘤 血管畸形
其他题名Coblation technique for the treatment of pharyngo-laryngeal hemangiomas and vascular malformations
分类号R739.63
摘要

目的 初步探讨低温等离子射频消融术治疗咽喉血管瘤和血管畸形的有效性和安全性。方法  2015年8月~2016年8月,共9例咽喉血管瘤病人于北京大学第一医院采用了低温等离子射频消融技术完成了血管瘤的消融治疗。术中创新性地应用低温等离子刀头在血管瘤或血管畸形表面进行消融。根据研究对象Mulliken分类的病理学特点分为A、B、C三组。A组为低流速局限性血管瘤和血管畸形,共6例,采用单纯低温等离子射频消融术治疗,至瘤体彻底消除,术后3个月未完全消退则施行第二次、进而第三次消融治疗。B组为低流速非局限性血管畸形,共2例,采用低温等离子消融联合博来霉素注射治疗,至瘤体缩小。C组为高流速血管畸形 1例,采取等离子射频消融配合颈外入路手术。对所采用的手术技术要点、病变切除程度、术后并发症和近期疗效进行总结。结果A组术中出血量1~15 ml,手术时间6~80 min,术后住院时间2~10 d;5例施行一次消融术,1例术后4个月施行二次消融术,随访3~8个月未复发;所有病人均未出现咽喉水肿、呼吸困难及感染等并发症。B组术中出血量5~15 ml,手术时间87~109 min,术后住院时间2~3 d,2例瘤体体表术中均对低温等离子射频消融具有明显的回缩反应。C组术中出血量900ml,手术时间 410 min,术后住院时间10 d,共施行2次消融治疗,第二次因术中难以控制的出血改为颈外入路手术。结论  应用低温等离子射频消融术治疗咽喉部血管瘤和血管畸形,具有术中出血少、组织损伤小、术后反应轻等优势,对于咽喉部低流速局限性的血管瘤和血管畸形是为一种安全有效的治疗方式。但对于低流速非局限性和高流速血管畸形,其可行性和安全性仍值得临床进一步研究。本技术在治疗咽喉部血管瘤和血管瘤的疗效仍需进一步的积累经验、长期的随诊观察以及大样本的临床随机对照研究。

英文摘要

Objective: To assess the effectiveness and safety of coblation treatment for pharyngo-laryngeal hemangiomas and vascular malformations.Method: Nine patients who underwent coblation surgery in Peking University First Hospital were enrolled. They were classified into A, B and C three groups according to the Mulliken classification. Group A of localized low-flow vascular malformations and hemangiomas, a total of six cases,received coblation surgery only. Group B of non-localized low-flow vascular malformations, 2 cases, received coblation surgery combined with bleomycin injection therapy. Group C of high-flow vascular malformations, 1 case, underwent coblation approach followed with tumor removal surgery as a rescue measure to control intraoperative bleeding.Operative procedure, complications and effectiveness were assessed.Result:GroupA, 6 patients, intraoperative blood loss was 1~15ml, mean operative time was6~80min, and postoperative hospitalized staywas 2~10d.Five cases were performed one-timecoblation surgery and one patients underwent secondary coblation surgery 4 months after the first surgery, followed up for 3 to 8 months without recurrence. All cases displayed no complications such as throat edema, dyspnea or infection. Group B, intraoperative blood loss was 5~15ml, mean operative time was 87~109 min, and postoperative hospitalized stay was 2~3d.The tumor protruding surface displayed an obviousretraction. Group C, one patient who was intraoperatively transferred to surgery due to uncontrollable intraoperative bleeding, blood loss was 900 ml, operative timewas 410 min, postoperative hospital stay was 10d.Conclusion:Coblation treatment for pharyngo-laryngeal hemangiomas and vascular malformations demonstrated effectiveness and safety in localized low-flow vascular malformations and hemangiomas,but limitation for non-localizedlow-flow and high-flow vascular malformations. Coblation treatment for pharyngo-laryngeal hemangiomas and vascular anomalieswarrants further experience, long-term follow up and large sample randomized control trials.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/125269
专题北京大学第一临床医学院
作者单位北京大学第一临床医学院
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GB/T 7714
白静. 低温等离子射频消融术治疗咽喉部血管瘤和血管畸形[D]. 北京大学第一临床医学院. 北京大学,2016.
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