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目的 探讨采用缝扎结合肿胀技术替代头颈部体表动静脉畸形切除术前介入栓塞的可行性及效果.方法 2007年7月-2010年11月,收治头颈部体表动静脉畸形患者9例.男4例,女5例;年龄8个月～55岁,中位年龄21岁.先天畸形6例,外伤后诱发2例,原因不详1例.病变部位:额颞部2例,面颊部2例,枕颈部2例,颞顶部1例,上唇1例,下唇1例.动静脉畸形范围2.2 cm × 1.2 cm～13.0 cm×10.0 cm.根据Schobinger分级:Ⅱ级8例,Ⅲ级1例.畸形涉及2～7条主要滋养动脉,滋养动脉直径1.7～3.1 mm.6例一期手术切除动静脉畸形直接缝合或植皮、局部皮瓣修复;3例一期皮肤扩张,二期手术切除动静脉畸形、扩张皮瓣修复.切除动静脉畸形前首先用7号丝线缝扎滋养动脉,病灶外周间断缝扎全层软组织2圈,病灶范围内肿胀液超量灌注.结果 术后除1例切口部分裂开,其余患者皮瓣、植皮均顺利成活,切口均Ⅰ期愈合.手术时间42～367 min,平均136 min;术中失血量15～1000mL,平均268 mL;术中输血1例,共输血3U.患者均获随访,随访时间2年～6年6个月,平均4.2年.随访期间动静脉畸形无复发.患者自评外观满意或基本满意5例,可以接受4例.结论 缝扎结合肿胀技术操作简便,术中出血少,可以部分替代头颈部体表动静脉畸形切除术前介入栓塞.“,”Objective To evaluate the feasibility and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peri pheral arteriovenous malformations (AVMs) of the head and neck.Methods Between July 2007 and November 2010,9 patients with peripheral AVMs of the head and neck were treated,including 4 males and 5 females with a median age of 21 years (range,8 months to 55 years).The causes were congenital malformation in 6 cases,trauma in 2 cases,and unknown origin in 1 case.The lesions were located at the frontotemporal region in 2 patients,cheek in 2 patients,occipitocervical region in 2 patients,temporoparietal region in 1 patient,upper lip in 1 patient,and lower lip in 1 patient.The size of the AVMs lesions ranged from 2.2 cm × 1.2 cm to 13.0 cm × 10.0 cm.Of 9 cases,8 were classified as Schobinger grade Ⅱ and 1 as grade Ⅲ.The AVMs involved 2 to 7 main nutrient arteries,with a diameter range of 1.7-3.1 mm.At one-stage operation,AVMs was removed and direct suture,skin graft or flaps were used for repair in 6 cases; the skin was expanded at one-stage operation,and then AVMs removal and repair were performed at twostage operation in 3 cases.Before resection of AVMs,No.7 silk suture was used to ligate the main nutrient vessels,and then annular interrupted suture of soft tissue was performed with the silk sutures around the lesions,at least two rings.Tumescent anesthetic solution was injected into lesions,and super wet end-point achieved.Results Partial incision dehiscence occurred in 1 patient; the flaps and grafting skin survived,and primary healing of incision was obtained in the other patients.The mean operation time was 136 minutes (range,42-367 minutes).The mean intraoperative blood loss was 268 mL (range,15-1 000 mL).Only 1 patient received 3 units of blood transfusion.All patients were followed up for 4.2 years on average (range,2 years to 6 years and 6 months); there was no recurrence case.The self-assessment cosmetic results were excellent or good in 5 cases and fair in 4 cases.Conclusion Intensive suture ligation followed by super-wet tumescent techniques might partially substitute preoperative embolization to facilitate surgical resection of peripheral AVMs of the head and neck,due to simple operation and less bleeding.