球形细胞静脉畸形的临床表现、病理特征及治疗策略  

Clinical presentations,pathological features and therapy of the glomuvenous malformation

作　　者：陈辉[1] 金云波[1] 马刚[1] 胡晓洁[1] 陈达[1] 江成鸿[1] 林晓曦[1] CHEN Hui JIN Yun-bo MA Gang HU Xiao-jie CHEN Da JIANG Cheng-hong LIN Xiao-xi.(Department of Plastic and Reconstructive Surgery, Shanghai Ninth People＇s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海200011

出　　处：《中国美容整形外科杂志》2016年第10期596-599,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的研究球形细胞静脉畸形(glomuvenous malformation,GVM)的临床表现和病理特征,分析GVM与普通静脉畸形(venous malformation,VM)差异,并探索可行的治疗方法。方法对病理确诊的7例GVM患者,分析其临床表现、影像学资料和病理特征。采用无水乙醇硬化、泡沫硬化剂(聚多卡醇)注射和长脉冲1064 nm Nd:YAG激光进行单一治疗或自身对照治疗,观察病灶消退情况及不良反应。结果 GVM为蓝紫色斑块或肿块,表面密集紫红色丘疹样"血疱",无明显压缩感,体位试验阴性;MR示病灶仅累及皮肤及浅筋膜层;病理上,GVM血管壁环绕较多球形细胞;无水乙醇血管内治疗能缩小病灶(n=6),但易出现组织坏死(n=2),聚多卡醇可缩小病灶(n=4),激光能有效清除表浅病灶(n=3)。结论依据病灶表面丘疹样"血疱"及病理上球形细胞包绕于血管腔的特征,可与普通VM相鉴别。血管内和激光治疗对GVM有效,但较普通VM易发生组织坏死的不良反应。Objective To study the clinical presentations and pathological features of glomuvenous malformation （GVM）, clarify the differences between GVM and common venous malformation （VM） and explore the appropriate therapy for GVM. Methods Seven cases were diagnosed as GVM by biopsy. Their clinical data, radiologicaland pathological features were analyzed retrospectively. Three therapies, intravascular embolization with absolute ethanol, foam sclerosing agent （pofidocanol） injection, and long-pulse 1064 nm Nd ：YAG laser, were performed independently or simuhaneously. Results GVMs were nodular and scattered, or plaque-like with blue or dark blue coloration. Densely distributed purple papule-like blood blisters were noted on the surface of lesions. GVMs were mainly located on the trunk or extremities and only involved skin and subcutaneous tissues revealed by MR. GVMs could not be completely emptiedby compression and posture tests were negative. Cords and clusters of glomus cells were seen around dilated, thin-walled vascular channels pathologically. Both absolute ethanol （ n= 6） and polidocanol （n=4） were effective, however tissue necrosis （n=2） occurred when absolute ethanol was used. Laser had an efficient removal of superficial lesions （ n= 3）. Conclusion GVM can be distinguished from common VM by purple popnlar-like blood blisters on lesions combined with pathological glomus cells. Absolute ethanol or polidocanol embolization and long-pulse 1064 nm Nd：YAG laser therapy were effective, while tissue necrosis should be avoided.

关 键 词：球形细胞静脉畸形 静脉畸形 病理 鉴别诊断 

分 类 号：R654.3[医药卫生—外科学]