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Objective@#To explore the clinical classification of microcystic lymphatic malformations of tongue and observe the treatment of microcystic lymphatic malformations of tongue by retrospective analysis, in order to provide reference for clinical practice.@*Methods@#From October 2005 to October 2015, the complete data of 220 cases of microcystic lymphatic malformations of tongue (115 males and 105 females) received and treated in Provincial Special Department of Vascular Anomalies, Linyi Tumor Hospital was analyzed retrospectively. The age ranged from 8 months to 52 years old, with a median age of 16 years old. All patients were followed up for 3 years, and according to their clinical manifestations, they were divided into three types: localized type of 23 cases, diffuse type of 161 cases, and megaloglossia type of 36 cases. Injection with pingyangmycin merely was performed on 58 cases, whereas merely surgery on 20 cases, injection with pingyangmycin combined with high frequency electrocoagulation on 55 cases, and surgery combined with injection with pingyangmycin on 87 cases. The therapeutic effect was evaluated according to the grade 4 standard. The χ2 test was used for statistical analysis of count data. Rank sum test was used for statistical analysis of ranked data.@*Results@#The percentage of surgery merely of localized type was 87.0% (20/23), significantly higher than that of other types of lesions [0% (0/197)] (χ2=178.060, P<0.001). The percentage of injection with pingyangmycin of diffuse type was 100% (161/161), significantly higher than that of other types of lesions [66.1% (39/59)] (χ2=60.034, P<0.001). The percentage of surgery combined with injection with pingyangmycin of megaloglossia type was 100% (36/36), significantly higher than that of other types of lesions [27.7% (51/184)] (χ2=65.800, P<0.001). After follow-ups for 3 to13 years, there were 0 cases of gradeⅠ, 11 cases of grade Ⅱ, 50 cases of grade Ⅲ, and 159 cases of grade Ⅳ. There were statistically significant differences in clinical efficacy among different clinical types (H=158.668, P<0.001). The percentage of level Ⅳ efficacy of localized type, diffuse type and megaloglossia type were 100% (23/23), 82.6% (133/161) and 8.3% (3/36) respectively. Local mucosa ulcer appeared in 45 cases and was cured through oral care and expectant treatment. Fever occurred in 28 cases and returned to normal within 24 h after expectant treatment. The lingual frenum was shortened in 16 cases. There were 12 cases with mild tongue swelling, 6 cases with influence on eating but without influence on breathing, and recovered spontaneously one week later.@*Conclusions@#The choice of different treatment methods of microcystic lymphatic malformations of tongue should be made according their clinical classification. The only surgical resection is recommended for localized protrude lesions. Injection with pingyangmycin in high tension combined with surgical resection or high frequency electrocoagulation is effective for diffuse lesions. Surgical resection combined with injection with pingyangmycin is suitable for the patients with megaloglossia type.
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Data of patients with maxillofacial and jugular venous malformations involving isthmus faucium area from January 2012 to July 2016 were collected. Patients were questioned about the medical history before operation, and the airway was adequately evaluated. The patients diagnosed as having non-difficult airways were endotracheally tubed using fast induction of anesthesia. Tracheal intubation was per-formed using fast induction of anesthesia combined with topical anesthesia after visual laryngoscopy in the patients assessed as having difficult airways. Endotracheal intubation was guided with a visual hard endo-scope or a fibrobronchoscope in the patients with difficulty in opening mouth after multiple treatments. Post-operative airway management was as follows: the tracheal tube was removed after extubation, the tracheal tube was retained for 24-48 h, or preventive tracheotomy was performed. Oxygen was inhaled by mask. A total of 157 patients were included in this study, 55 patients diagnosed as having difficult airways, and a-mong the 55 patients, 87％ cases were intubated after visual laryngoscopy and 13％ cases received tracheot-omy. There were 10 patients with difficulty in opening mouth after multiple treatments and 5 cases under-went tracheotomy in the outer hospital. Sixteen patients presented with a transient increase in airway pres-sure during intraoperative injection of anhydrous ethanol. There were 106 cases in whom the tracheal tube was removed immediately after emergence, and among them, 32. 1％ cases needed tongue traction and 2. 8％ cases underwent emergency tracheotomy after extubation. Thirty-eight patients needed to retain the tracheal tube for 24-48 h after operation, and among them, 37％ cases needed tongue traction and 3％ ca-ses required emergency tracheotomy after extubation. Thirteen cases underwent preventive tracheotomy. The preoperative visit and assessment are especially important, appropriate airway management strategies should be developed, vital signs should be closely observed during operation, and the timing of extubation should be grasped for this type of patients, and the SpO2 and airway pressure should be mainly observed during op-eration especially for the patients who underwent anhydrous ethanol injection.
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Objective@#To evaluate the efficacy and feasibility of radiofrequency ablation(RFA) for complicated diffuse arteriovenous malformations.@*Methods@#From Dec. 2014 to Dec. 2016, 12 cases with complicated diffuse arterioveneous malformations were treated by RFA in our hospital. The clinical records were retrospectively reviewed. The lesion size ranged from 10 cm×7 cm to 28 cm×30 cm. Ablation procedures with " high power and long time" technique were performed under real time color Doppler monitoring. The impedance model were used and ablation needles were punctured into core lesions with the most abundant blood flow. Power was set as 90 to 110 W for central core lesions, and 60 to 80 W for superficial or surrounding lesions. The average ablation time was from 60 to 90 min (average, 75 min). Next treatment would be performed 3 months later when neccessary. The therapeutic efficacy was evaluated on a 4-level scale.@*Results@#Hyperpyrexia occurred in 1 patients during first and second treatments. Transient postoperative hemoglobinuria occurred in 2 patient. Full thickness defects induced by tissue necrosis in the original ulcer area of cheek occurred in 1 patient, which was reconstructed with pedicle Trapezius muscle myocutaneous flap. Bleeding symptom in 7 cases stopped after only 1 treatment. After a follow-up period of 1-3 years, the efficacy was graded as Ⅳ in 8 case, as Ⅲ in 4 cases.@*Conclusions@#For complicated diffuse arteriovenous malformations, radio frequency ablation with "high power and long time" technique under real time color Doppler monitoring can completely damage the deep core soft lesions, and control the life-threatening hemorrhage effectively, which can be recommended as the alternative therapy when surgery, interventional embolizationor or sclerosant injection can not control the lesions.
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Objective To observe the clinical effects and complications of percutaneous radio frequency ablation.Methods Clinical records from 24 patients with complex venous malformations that underwent percutaneous radiofrequency ablation (RFA) from Dec.2014 to Dec.2015 at a singleinstitution were reviewed.There were 14 males and 10 females.The median age was 11 years ranging from 1.5 to 42 years.There were 13 cases with extensive lesions and 11 cases with deep localized lesions.Coagulopathy occurred in 4 patients with extensive lesions.Ablation procedures were performed under real-time color Doppler monitoring by percataneous radiofrequency dynamic ablation with low power,and the therapeutic efficacy was evaluated on a 4-level scale.Results There were 12 grade Ⅳ cases,9 grade Ⅲ cases,3 grade Ⅱ cases and 0 grade Ⅰ case after 15 to 28 months' follow-up.All 4 patients had improvement in coagulopathy.There were 9 cases with grade Ⅳ therapeutic efficacy in patients with deep localized lesions,compared to 3 in patients with extensive lesions,which indicated a significant differences between these two groups (P＜0.05).Conclusions Moving radiofrequency ablation with low power is feasible and safe in venous malformations treatment,which can be recommended as the replacement for surgery or sclerotreatment,being especially indicated in those with deep lesions.Obvious improvement in coagulopathy and pathogenetic condition can be achieved after ahlation in those with extensive lesions.
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Objective To assess the significance of the right paraesophageal node(Ⅵb area) dissection in cN0 stage papillary thyroid microcarcinoma(PTMC)central lymph node dissection.Methods The clinical data of three hundred and five cN0 PTMC patients who underwent radical thyroidectomy from 2010 to 2015 was retrospectively analyzed.The metastasis rate of central compartment(Ⅵa area.Ⅵb area)and the clinical data were collected and analyzed.Results 305 cN0 stage PTMC patients underwent total thyroidectomy and bilateral central compartment dissection or right lobectomy combined with ipsilateral central compartment dissection,the mean diameter of the tumors was 6.75 mm.The incidence rate of central compartment metastasis was 35%.The incidence rate ofⅥb area metastasis was 11.1%.The status ofⅥb area metastasis was correlated with major clinicopathologic parameters such as sex,age<45,tumor diameter≥0.8 cm,bilateral multiple lesions, capsule invasion,VI a lymph node metastasis≥3 were all related risk factors of PTMC VIb area metastasis(χ2=6.913,4.241,4.517,5.185,12.400,34.745,P<0.05).Conclusion Because of the high rate of central lymph node metastasis in patients with PTMC and the poor efficiency in the evaluation for central lymph node metastasis before operation,the right paraesophageal lymph nodes(Ⅵb area)dissection is needed to be done in cN0 stage PTMC patients with tumor size≥0.8 cm,multifocal lesions,membrane invasion,Ⅵa area metastasis≥3,especially male patients.
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Objective@#To analyze the clinical data and summarize therapeutic experiences of cervicofacial venous malformations involving isthmus faucium area.@*Methods@#Clinical records from 143 patients with venous malformations involving isthmus faucium area treated at our hospital between January 2012 and January 2016 were reviewed. There were 70 males and 73 females. Age ranged from 1 to 52 years old, with a median age of 14.5 years. There were 19 cases with lesions involving in only 1 subanatomic area above and 124 cases with lesions involving in more than 1 subanatomic areas, including 63 cases with lesions involving in more than 2 areas. There were 50 patients presenting with additional maxillofacial and cervical lesions. Clinical symptoms included snoring (n=98), indistinct phonation (n=49), and tonsil hypertrophy more than degree Ⅱ (n=19). Tracheotomy was performed in 3 patients prior to hospitalization, contigency tracheotomy during hospitalization in 10 patients, and oral trachea cannula in other patients. All therapeutic procedures, including single chemical ablation with ethanol injection (n=94), single lesion resection (n=9) and both of them (n=40), were performed under general anesthesia. Treatment remedies included mesh suture, macroglossia reduction and excision of maxillofacial and cervical lesions for patients presenting with extensive malformations extending to maxillofacial and cervical area. Tonsil resection were done in patients having tonsil venous malformations or tonsil hypertrophy more than degree II. Achauer′s 4-grade criterion was applied to evaluate the treatment outcomes. SPSS 18.0 software was used to analyze the data.@*Results@#Trachea cannula were not extubated untill 24 to 48 hours after treatment. Emergency tracheotomy was done in 2 cases after extubations because of dyspnea, and successful extubations were obtained in other cases. There were no advents of pulmonary vascular spasm or pulmonary embolism. There was significant difference between before and after operation (snore: χ2=105.431, ambiguous pronunciation: χ2=59.698, tonsil hypertrophy more than degree Ⅱ: χ2=33.530, all P<0.01). The patients were followed-up for 1-4 years, and there were 123 cases at grade Ⅳ (complete disappear of lesions in 62 cases without recurrence), 17 at grade Ⅲ , 3 at grade Ⅱ, and no case at gradeⅠ.@*Conclusions@#Chemical ablation with ethanol injection for venous malformations involving isthmus faucium area is recommended, wheras combined remedies including injection, mesh suture, macroglossia reduction, and excision of cervicofacial lesions are suggested in treatment of extensive lesions extending to maxillofacial and cervical area. Tonsil resection should be done in patients having tonsil venous malformations or tonsil hypertrophy more than degree Ⅱ, which is safe and highly effective, with good reservation of function, in the treatment of maxillofacial and cervical venous malformations involving isthmus faucium area.
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Objective To investigate the feasibility of reconditioning post-sclerotherapy basifacial depressions for venous malformations with the axis platysma-fascial flap including submental artery.Methods Fifteen cases of post-sclerotherapy depressions of venous malformations were treated from Dec.2008 to Oct.2013.Preoperative color Doppler ultrasonography was routinely performed to localize and mark sublingualissubmental artery.Upper hind neck incision was made to dissociate depressed and donor area,after which reconstruction were performed with axis platysma-fascial flap including submental artery.3 months to 2 years' follow-ups were conducted to observe clinical effects.Results All the flaps were alive in all the 15 cases.Satisfacfory recovery archeived because the depressed area appeared well-stacked wihtout secondary depression in the neck.Conclusions It is recommended that axis platysma-fascial flap should be the first chioce of reconditioning basifacial postsclerotherapy depressions for venous malformations,as the operations can be peformed easily under concealed incision with abundant tissues supply and high survival rate.
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<p><b>OBJECTIVE</b>To explore the factors that affect the curative effect and the best method of treatment for the patients with maxillofacial cavernous hemangiomas.</p><p><b>METHODS</b>102 cases of maxillofacial cavernous hemangiomas were performed DSA examination and taken serial photography. According to the diameter, number and draining speed of efferent veins of the tumor, the cavernous hemangiomas were classified into two types-the high efferent speed and low efferent speed type. For all of them, were randomly performed embolization of efferent veins with absolute ethanol plus bleomycin-A5 intratumor injection (group I) and bleomycin-A5 intratumor injection alone (group II).</p><p><b>RESULTS</b>The cure rate and general effective rate has significant difference (P < 0.01) between two groups in 70 patients with high efferent speed veins, while no significant difference (P > 0.05) in 32 patients with low efferent speed veins.</p><p><b>CONCLUSIONS</b>This new classification is beneficial for seeking method of treatment. The embolization of efferent veins is an effective method for cavernous hemangioma with high efferent speed veins; but for the type with low efferent speed veins, bleomycin-A5 intratumor injection alone could acquire a good results.</p>