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【症例】初回術後14ヵ月で再増大し、2回目の摘出術で制御できた巨大顎下部動静脈奇形の1例

発表形態：: 資料・解説・論説・研究報告・総合雑誌の論文
主要業績：: 主要業績
単著・共著：: 共著
発表年月：: 2019年02月

DOI：: 10.5106/jjshns.29.79
会議属性：: 指定なし
査読：: 有り
リンク情報：

日本語フィールド

著者：

鈴木久美子, 峯崎晃充, 倉富勇一郎

題名：

【症例】初回術後14ヵ月で再増大し、2回目の摘出術で制御できた巨大顎下部動静脈奇形の1例

発表情報：

頭頸部外科巻: 29 号: 1 ページ: 79-85

キーワード：

概要：

動静脈奇形(AVM)は経時的に増大し、進行例ではしばしば治療抵抗性となる。今回われわれは、初回手術後に再発し、再手術後に良好な経過を得た巨大顎下部AVMの1例を経験したので報告する。症例は28歳、男性。顎下部に8cmのAVMを認めた。術前血管塞栓術を行い、2日後に摘出術を行った。舌骨上面から多量出血があり、総出血量は1,458mlだった。術後14ヵ月でAVMは再発し、再手術を行った。血管塞栓術は行わず、栄養血管を遠位部で結紮切断しながら舌骨とその下部の流入動脈を含めてAVMを摘出した。総出血量は1,039mlだった。術後3年9ヵ月を経過した現在、再発は認めていない。AVMを再発なく摘出するには、流入動脈のすべてを適切に切断することが重要と思われた。

抄録：

英語フィールド

Author：

Kumiko Suzuki, Akimichi Minesaki, Yuichiro Kuratomi

Title：

Regrowth of a large arteriovenous malformation in the submandibular region 14 months after the initial surgery, successfully controlled by a second surgery : A case report

Announcement information:

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY Vol: 29 Issue: 1 Page: 79-85

An abstract：

Arteriovenous malformation （AVM） often progresses and recurs after treatment. The management of advanced AVM is frequently difficult. We herein report a case of a large AVM in the submandibular region that regrew 14 months after the initial surgery, controlled by a second surgery. The patient was a 28-year-old man who was referred to our hospital with complaints of swelling in the submandibular region. A pulsating lesion measuring approximately 8 cm in diameter was found, and was diagnosed as AVM. The patient underwent surgical resection two days after arterial embolization. During the surgery, the feeding vessels of the AVM were ligated and cut at the distal position; however, diffuse bleeding from the surface of the AVM occurred. The AVM was attached to the hyoid bone, and profuse arterial bleeding from the hyoid bone occurred when the AVM was separated from the bone. The intraoperative blood loss was 1,458ml. The AVM regrew 14 months after the initial surgery, so we performed a second surgery without preoperative embolization. During the second surgery, the hyoid bone and feeding artery under the hyoid bone penetrating the hyoid bone were resected along with the AVM. The intraoperative blood loss this time was 1,039ml. No recurrence of the AVM was observed at three years and nine months after the second surgery. The present case suggests that the accurate ligation of all feeding vessels is important in order to resect AVM without recurrence.