手术治疗坐骨神经区域脉管性疾病的临床效果  

Clinical effect of surgical treatment of vascular anomalies in the sciatic nerve region

作　　者：肖莉[1] 王彦林[1] 刘秋雨[2] 刘大看[1] 董长宪[1] 左松[1] Xiao Li;Wang Yanlin;Liu Qiuyu;Liu Dakan;Dong Changxian;Zuo Song(Department of Hemangioma Surgery in Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院血管瘤科,郑州450003 [2]河南省人民医院病理科,郑州450003

出　　处：《中华整形外科杂志》2022年第3期265-274,共10页Chinese Journal of Plastic Surgery

摘　　要：目的探讨手术治疗坐骨神经区域脉管性疾病的临床效果。方法回顾性分析2013年6月至2018年12月河南省人民医院血管瘤科收治的采用手术治疗的坐骨神经区域疼痛、有功能障碍的脉管性疾病患者的临床资料。记录手术时间、术中出血量、住院时间、术后并发症及切口愈合情况。术后进行随访,包括体格检查和影像检查。采用视觉模拟评分法(VAS)评估术前和术后出院时疼痛强度,0%为无痛,10为剧痛。通过Oswestry功能障碍指数(ODI)评估术前、术后随访时疼痛和肢体功能,0%为正常,越接近100%,功能障碍越严重。结果共纳入76例患者,男32例,女44例,年龄2~55岁,其中静脉畸形(VM)48例,动静脉畸形(AVM)9例,淋巴管畸形(LM)6例,纤维脂肪性血管性病变(FAVA)13例。76例中有13例VM曾行局部硬化剂注射治疗,4例AVM曾行介入栓塞治疗,症状无改善或加重。FAVA病例的手术时间、术中出血量、住院时间分别为(113.33±30.11)min、(81.67±22.29)ml、(3.83±0.98)d,均少于其他3种脉管性疾病,手术损伤最小、恢复最快;AVM病例手术时间、出血量及住院时间分别为(288.33±33.71)min、(981.67±164.85)ml、(11.17±1.47)d,均多于其他3种脉管性疾病;VM与LM病例手术时间接近;VM病例术中出血量[(396.67±85.71)ml]相差较大,最少为150 ml,最多为1100 ml。所有病例术中及术后生命体征平稳,均未出现大血管、神经损伤,术后71例患者切口甲级愈合,4例切口乙级愈合,1例切口丙级愈合。术后随访6~36个月,平均13个月。末次随访时73例疼痛完全缓解,3例疼痛部分缓解;72例下肢功能恢复正常,4例改善;磁共振或CT血管造影检查显示,70例瘤体消失,6例瘤体有残存。VM、AVM、LM、FAVA病例术前疼痛VAS评分分别为2.00(1.00,3.75)分、2.00(1.00,3.50)分、4.00(0.75,6.25)分、4.00(1.50,6.00)分,术后均为0.00(0.00,0.00)分;术前ODI分别为17.78%(15.56%,22.22%)、17.78%(13.33%,35.56%)、50.00%(31.67%,8Objective This study aims to discuss the clinical effect of surgical treatment of vascular anomalies in the sciatic nerve region.Methods Retrospective analysis of clinical data was performed on patients with pain and dysfunction in the sciatic nerve region in the Department of Hemangioma,Henan Provincial People’s Hospital,between July 2013 and December 2018.The operation time,intraoperative blood loss,hospitalization time,postoperative complications,and wound healing were recorded.Postoperative follow-up included physical and imaging examination.Visual analogue scale(VAS)was used to evaluate the pain intensity before operation and at discharge.Oswestry dysfunction index(ODI)was used to evaluate the pain and limb function before operation and during follow-up.Results This study enrolled 76 cases(32 males,aged from 2 to 55 years),including 48 cases of venous malformation(VM),9 cases of arteriovenous malformation(AVM),6 cases of lymphatic malformation(LM),and 13 cases of fibro-adipose vascular anomaly(FAVA).Thirteen patients had been treated with local sclerotherapy,and four patients had been treated with interventional embolization for AVM without improvement or exacerbation.The operative time,intraoperative blood loss,and hospitalization time of FAVA patients were(113.33±30.11)min,(81.67±22.29)ml,and(3.83±0.98)d respectively,which were less than those of the other three vascular anomalies with the lest surgical damage and quickest recovery.The operative time,intraoperative blood loss,and hospitalization time of AVM patients were(288.33±33.71)min,(981.67±164.85)ml,and(11.17±1.47)d respectively,which were more than those of the other three vascular anomalies.The operation time of VM and LM cases was close,but the amount of blood loss[(396.67±85.71)ml]in VM cases varies greatly,with a minimum of 150 ml and a maximum of 1100 ml.The vital signs of all patients were stable during and after the operation,without injury of main vessels and nerves.Seventy-one patients had grade A wound healing,four patients had gr

关 键 词：坐骨神经 脉管性疾病 外科手术 随访研究 

分 类 号：R654.3[医药卫生—外科学]