半导体激光腔内消融治疗肢体超干型静脉畸形的临床效果  

Clinical effect of endovenous laser ablation in treating congenital extratruncular venous malformations of limbs

作　　者：王瑞华 杨心蕊[1] 吴小雨 刘光[1] 叶开创[1] 李维敏[1] 刘晓兵[1] 殷敏毅[1] 黄新天[1] 陆信武[1] Wang Ruihua;Yang Xinrui;Wu Xiaoyu;Liu Guang;Ye Kaichuang;Li Weimin;Liu Xiaobing;Yin Minyi;Huang Xintian;Lu Xinwu(Department of Vascular Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University,School of Medicine,Vascular Center of Shanghai Jiao Tong University,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血管外科上海交通大学血管病诊治中心,上海200011

出　　处：《中华血管外科杂志》2021年第1期17-21,共5页Chinese Journal of Vascular Surgery

基　　金：上海市2020年度“科技创新行动计划”医学创新研究专项(20Y11909600)。

摘　　要：目的:观察超声引导下经皮半导体激光腔内消融治疗肢体超干型静脉畸形(EVMs)的临床效果。方法:回顾性分析上海交通大学医学院附属第九人民医院血管外科2016年1月至2018年12月连续收治172例采用半导体激光腔内消融治疗的肢体EVMs患者的临床资料,其中男性78例,女性94例。所有患者均有病变部位不同程度肿胀、疼痛,术前行MRI明确病变范围。评估患者手术成功率、围术期并发症发生率(皮肤损伤、神经损伤)及死亡率,术后观察病变部位体积变化以及肿胀、疼痛缓解情况。结果:172例患者均成功施行激光腔内消融治疗,手术成功率100%。皮肤灼伤2例(1.16%),治疗部位感觉异常13例(7.56%),皮下瘀斑67例(38.95%)。随访时间为(12.90±4.84)个月,随访期内163例(94.77%)病变部位疼痛缓解,111例(64.53%)肿胀缓解。术后12个月畸形病灶直径与治疗前相比,差异有统计学意义[(7.85±2.89)cm比(16.36±3.05)cm,t=23.879,P<0.01]。无骨筋膜室综合征发生,无严重神经功能损伤导致的长期功能障碍,无下肢深静脉血栓形成及肺栓塞事件发生,无死亡事件发生。结论:超声引导下,半导体激光腔内消融治疗EVMs是一种安全、有效的方法,具有微创、并发症少的优点。Objective To observe the clinical effect of endovenous laser ablation(EVLA)on the treatment of extratruncular venous malformations(EVMs)of limbs under ultrasound guidance.Methods A retrospective analysis of 172 consecutive patients(78 males and 94 females)with limbs congenital EVMs treated with EVLA from Jan.2016 to Dec.2018 was conducted.All patients had different degrees of swelling and pain in the lesions,and MRI was performed before surgery to determine the extent of the lesions.The success rate,perioperative complications(skin injury,nerve injury,etc.)and mortality were observed.The volume changes of the lesions and the swelling and pain relief were observed after the operation.Results In this study,172 patients underwent EVLA under local or general anesthesia,and the success rate was 100%.There were 2 cases of skin burns(1.16%),13 cases of paresthesia at the treatment site(7.56%),and 67 cases of subcutaneous petechiae(38.95%).The follow-up time was(12.90±4.84)months.The diameter of the lesions at 12 months after surgery was significantly different from that before treatment[(7.85±2.89)cm vs(16.36±3.05)cm,t=23.879,P<0.01].Pain relief in 163 cases(94.77%),swelling relief in 111 cases(64.53%)were found.There was no osteofascial compartment syndrome,no long-term dysfunction caused by severe neurological damage,no deep vein thrombosis of the lower limbs,no pulmonary embolism and no death.Conclusion Under the guidance of ultrasound,semiconductor laser intravenous ablation is a safe and effective method for the treatment of congenital EVMs,which has the advantages of minimally invasive and fewer complications.

关 键 词：激光腔内消融 静脉畸形 超干型 

分 类 号：R654.4[医药卫生—外科学]