累及眶区的巨大颅外Schobinger III期/Yakes IV型动静脉畸形的整块切除与斜方肌岛状皮瓣重建
En bloc resection and trapezius island flap reconstruction of giant extracranial Schobinger stage III/Yakes type IV arteriovenous malformations involving the orbital region.
文献信息
| PMID | 42718858 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Wei-Liang Chen |
| 作者单位 | Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120, China. |
| 期刊 | JPRAS open |
| SCI 分区 | Q2 |
| IF | 1.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 与严重出血相关的广泛头颈部动静脉畸形（AVMs）具有潜在致命性，并给头颈外科医生带来了重大挑战。
方法： 我们评估了2例患有危及生命的广泛Schobinger III期/Yakes IV型头颈部AVM的患者，分别为一名33岁男性（患者1）和一名38岁女性（患者2）。两例患者均接受了整块切除，并采用扩展垂直斜方肌肌皮岛状皮瓣（eTMF）重建由此产生的大型颅面缺损。患者2因同时合并上颌骨原发性T4a期鳞状细胞癌，同期接受了根治性颈淋巴结清扫术。
结果： 包括眶区受累在内的广泛头颈部AVM均被完全且安全地切除，可折叠的eTMF重建了由此产生的大型缺损。未发生手术并发症，术后外观可接受。吞咽、咀嚼和言语功能恢复至术前水平。生活质量评分提高了40个百分点，患者1达到80%，患者2达到60%。患者1在36个月随访后仍无病生存，而患者2在术后8个月死于局部复发。
结论： 对于危及生命、累及眶区的颅外Schobinger III期/Yakes IV型AVM患者，即使伴有上颌骨T4a期鳞状细胞癌，整块切除或根治性手术也是一种有效的治疗方法。可折叠的eTMF是重建广泛头颈部缺损（包括全层颊部缺损）的一种大容量、高度可靠的选择。
英文摘要
BACKGROUND: Extensive head and neck arteriovenous malformations (AVMs) associated with severe hemorrhage are potentially life-threatening and present substantial challenges for head and neck surgeons.
METHODS: We evaluated a 33-year-old man (Patient 1) and a 38-year-old woman (Patient 2) with life-threatening, extensive Schobinger stage III/Yakes type IV AVMs of the head and neck. Both patients underwent en bloc resection, and the resulting large craniofacial defects were reconstructed using an extended vertical trapezius myocutaneous island flap (eTMF). In Patient 2, simultaneous radical neck dissection was performed because of a concomitant primary T4a squamous cell carcinoma of the maxilla.
RESULTS: The extensive head and neck AVMs, including those with orbital involvement, were completely and safely resected, and the foldable eTMF reconstructed the resulting large defects. No surgical complications occurred, and postoperative appearance was acceptable. Swallowing, mastication, and speech were restored to preoperative levels. Quality-of-life scores improved by 40 percentage points, reaching 80% in Patient 1 and 60% in Patient 2. Patient 1 remained disease-free after 36 months of follow-up, whereas Patient 2 died of local recurrence 8 months after surgery.
CONCLUSIONS: En bloc resection or radical surgery is an effective treatment approach for patients with life-threatening extracranial Schobinger stage III/Yakes type IV AVMs involving the orbital region, even when accompanied by T4a-stage SCC of the maxilla. The foldable eTMF is a large, highly reliable option for reconstruction of extensive head and neck defects, including full-thickness cheek defects.