Vascular malformation
Introduction
Introduction to vascular malformation The vascular malformation is composed of numerous sinusoids lined with endothelial cells. The size and shape of the sinusoids are different, such as the sponge structure. The blood in the sinus cavity is coagulated into a thrombus and can be calcified into a venous stone. Classification of vascular malformations: (1) venular malformations. (2) venous malformations. ((3) arteriovenous malformation. (4) lymphatic malformation. (5) mixed malformation. Venous malformation often occurs in the cheeks, neck, eyelids, lips, tongue or mouth. The position is different, if the position is deep, then The color of the skin or mucous membrane is normal, and the superficial lesions are blue or purple. The boundary is not clear, the softness of the sputum can be compressed, and sometimes the venous stone can be found. When the head is low, the lesion area is congested and regained normal. After the position, the swelling also shrinks and returns to the original state. This is called positive positional movement test. The venous malformation can be injected into the lesion cavity with vascular sclerosing agent, which causes fibrosis and atresia of the lesion, causing the lesion to shrink or disappear. The commonly used drug is Pingyang. Streptomycin, bleomycin, etc. When injecting, it is necessary to crush the surrounding tissue, block the blood flow, and use small doses of multi-point sputum, each interval of 7 to 10 days. If the effect is not good, then the surgical resection or low temperature treatment. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: facial paralysis aphasia hemorrhagic shock
Cause
Causes of vascular malformation
Causes of vascular malformation
1. In the early embryonic period (8-December), the embryonic tissue is mechanically damaged. Local tissue hemorrhage causes some hematopoietic stem cells to be distributed to other embryonic characteristic cells, some of which differentiate into vascular-like tissues and eventually form vascular malformations.
2. During the development of human embryos, especially in the early stage of vascular differentiation, due to the small-scale misconfiguration of the control gene segments, the tissue differentiation of specific parts is abnormal and develops into vascular malformations.
Prevention
Vascular malformation prevention
Follow-up after discharge
1. Take medicine when you are discharged from hospital
Conventional antibiotics, if there is neurological damage, should be added with neurotrophic drugs.
2. Check items and cycles
Regular outpatient follow-up, followed up every six months to one year.
3. Problems that should be noted
Pay close attention to the lesions, such as signs of continued lesions should continue to be reviewed.
Complication
Vascular malformation complications Complications facial paralysis aphasia shock hemorrhagic shock
l. Hematoma
Often due to incomplete hemostasis during surgery, small hematoma can be pressure-wrapped and hemostasis drugs can be used to stop bleeding. If a large hematoma develops rapidly, it should be promptly surgically explored.
2. Infection
Infection can cause partial cracking. Attention should be paid to systemic antibiotics and local drainage.
3. Face
If it is only a nerve injury and does not cut the facial nerve: _ can be a neurotrophic drug, can recover after 3 to 6 months. If the nerve has been disconnected, a nerve anastomosis is required.
4. Blocking the common carotid artery or internal carotid artery for a long time can cause complications such as postoperative limb paralysis and aphasia.
Postoperative attention should be paid to the patient's consciousness, pupillary changes, muscle changes and physical activity. If abnormalities are found, neurosurgery should be consulted in time.
5. Hemorrhagic shock
Intraoperative attention should be paid to complete hemostasis. Postoperative attention should be paid to the observation of drainage. If the patient has rapid breathing, rapid pulse rate, decreased blood pressure, and wet limbs, he should be given oxygen, simple blood volume, and vasoactive drugs. Whether or not surgical exploration should be performed immediately depends on the bleeding condition.
Symptom
Symptoms of vascular malformation Common symptoms Persistent pain with mucous membrane mucosal bleeding Redness and swelling of the back of the hand
1. Venous malformations often occur in the cheeks, neck, eyelids, lips, tongue or mouth. The position is different. If the position is deep, the skin or mucous membrane is normal in color; the superficial lesion is blue or purple. The border is not clear, it is soft, it can be compressed, and sometimes it can reach the vein stone. When the head is low, the lesion area is congested and enlarged; after returning to the normal position, the swelling is also reduced, and the original state is restored. This is called the positional movement test.
2. Most of the venous malformations were not found at birth, and some also caused the patient's attention after the symptoms appeared in early childhood and even adulthood.
3. When the volume of venous malformation is small, there is generally no symptom. If you continue to develop and grow up, it can cause deformities and dysfunctions such as face, lips and tongue. If an infection occurs, it can cause pain, swelling, skin or mucous membrane ulcers, and there is a risk of bleeding.
Examine
Vascular malformation examination
Laboratory examination
Routine laboratory tests and cardiopulmonary tests to understand the patient's general condition and tolerance to surgery.
2. Imaging examination
(1) B-ultrasound
In particular, Doppler color Doppler has a high reference value for understanding the extent of blood mass and blood supply.
(2) CT examination of maxillofacial region and head and neck
It can fully display the extent of the tumor and its relationship with the surrounding tissue. The application of 3D reconstruction technology can more intuitively display the shape of the tumor. However, CT cannot accurately locate arteriovenous malformations.
(3) MRI and MRA examination of maxillofacial region and head and neck
Magnetic resonance angiography plays an important role in the diagnosis and treatment of arteriovenous malformations, and can accurately determine the location of arteriovenous and arteriovenous fistulas with abnormal anastomosis.
(4) sputum angiography and DSA
It is mainly used for the diagnosis of the main tumors of arteriovenous tumors and arteriovenous malformations. It can show the location, extent, blood supply source, reflux status and traffic conditions of peripheral blood vessels in detail. It is helpful to determine the surgical plan and estimate the difficulty of surgery. degree.
(5) X-ray surface tomogram
There are different manifestations of central arteriovenous malformations in the jaw, which need to be considered in combination with the above examinations.
Diagnosis
Diagnosis of vascular malformation
Diagnostic measures
The diagnosis of superficial hemangiomas or vascular malformations is not difficult. For the deep vascular malformation, it is a pity that the positional movement test, the light transmission test and the puncture are used for initial diagnosis. However, the positioning of arteriovenous malformation and the positioning of dynamic and static sputum need to rely on comprehensive considerations such as imaging examination. For the location of deep venous malformation, cystic pelvic deformity, etc., in order to determine the location, size, extent and anastomotic branch of the lesion, ultrasound, dynamic and angiography can be used to assist diagnosis. Diagnosis often depends on pathological diagnosis.
Differential diagnosis
From the point of view of cell biology classification, vascular lesions in adults are basically vascular malformations. Arteriovenous malformations and venular malformations in infants and young children. Lymphatic malformations are all vascular malformations. The so-called bayberry-like hemangioma that rises above the skin has a tendency to spontaneously resolve leopards, mostly hemangioma. The venous malformation found in infants and young children, especially at birth, is difficult to judge and needs to be considered comprehensively. Arteriovenous malformation is different from aneurysm and acquired arteriovenous fistula. An aneurysm is a kind of tumor-like dilatation caused by elastic fiber lesions in the middle wall of the arterial wall; acquired arteriovenous fistula is caused by local arterial dilatation after injury, and is caused by a vein that is accompanied by a vein. It is generally located deeper and more limited.
