栓塞硬化注射治疗肢体疼痛性静脉畸形  

Application of embolic sclerotherapy for the treatment of painful venous malformation in limbs

作　　者：黄莹滢[1] 欧阳天祥[1] 肖燕[1] 陈惠平[1] 虞杰[1] 马晓荣[1] 徐苗[1] 

机构地区：[1]上海交通大学医学院附属新华医院整形外科,200092

出　　处：《中华整形外科杂志》2015年第5期352-355,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨肢体疼痛性静脉畸形安全有效的治疗方法。方法①对诊断为肢体静脉畸形伴不同程度疼痛症状的97例患者，均行MRI检查确定畸形血管的位置、病变结构、大小、累及周围解剖结构的浸润范同，并行相关统计学分析。②先以栓塞剂无水乙醇注入静脉畸形血窦腔内，将病灶的回流血管栓塞，后注入聚桂醇与甲氨蝶呤混合的硬化剂持续作用于病灶，观察分析临床疗效。结果2010年1月至2012年1月，应用上述方法治疗97例疼痛性静脉畸形患者，Spearman相关分析结果显示，疼痛与瘤体的生长速度、体积、MRI分级没有显著的相关性（P〉0．05）。病变位于肌间隙者比肌肉、关节、皮下更易发生疼痛（P〈0．01），静脉畸形病变位于肌肉内的疼痛比位于皮下和关节处强，皮下和关节位置则无显著差异。一次栓塞硬化注射治疗后疼痛症状缓解率为95．9％（93／97），无一例出现远位栓塞、神经损伤或肌肉萎缩等严重并发症，经0．5～1．5年随访疼痛无复发。结论栓塞硬化注射治疗疼痛性静脉畸形创伤小、安全、疗效持续稳定。Objective To investigate the safe and effective treatment for painful venous malformation （VM） in limbs. Method （1） 97 cases with painful VM underwent MRI to detect the location of VM, as well as its size and structure, its relationship with the surrounding tissue. Statistical analysis was also performed. （2） The embolic agent （ethanol） was first injected to embolize the draining vessels of VM, then the Polidocanol plus Methotrexate （MTX） was followed to keep the embolization effect on VM. The therapeutic effect was observed and analyzed. Results From January 2010 to January 2012, 97 patients with painful VM were treated. A Spearman correlation analysis showed no significant correlation between symptoms of pain and lesion growth, volume, or MRI grades （P 〉 0.05）. The lesions in the muscle space are more likely to have the symptoms of pain （P 〈0.01 ） , followed by the lesions in the muscle, then the lesions in the joint and subcutaneous tissue. The pain relieve percentage was 95.9% （93/97） after one time embolic sclerotherapy. No severe complication, such as distant embolization, nerve damage, or muscle atrophy happened. No pain reoccurrence happened after 0.5 - 1.5 years of follow-up period. Conclusions The treatment of embolic scleratherapy is minimal invasive, safe and effective for painful VM with stable results.

关 键 词：静脉畸形 疼痛性 栓塞硬化 

分 类 号：R654.4[医药卫生—外科学]