博来霉素灌洗联合氰基丙烯酸异丁酯胶栓塞术治疗眼眶血管畸形的效果  

Treatment of orbital vascular malformations with intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization

作　　者：李月月 渠晓黎 马瑞[1] 胡健[1] 黑砚 徐文芹 吴畏 丁琢 杨新吉 Li Yueyue;Qu Xiaoli;Ma Rui;Hu Jian;Hei Yan;Xu Wenqin;Wu Wei;Ding Zhuo;Yang Xinji(The Ophthalmology Division of Chinese PLA General Hospital,Beijing 100039,China;Department of Ophthalmology,First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China)

机构地区：[1]解放军总医院眼科医学部,北京100039 [2]山东第一医科大学第一附属医院眼科,济南250014

出　　处：《中华眼科杂志》2023年第1期37-43,共7页Chinese Journal of Ophthalmology

基　　金：首都卫生发展科研专项(首发2020-2-5131)。

摘　　要：目的分析博来霉素灌洗联合氰基丙烯酸异丁酯胶栓塞术治疗眼眶血管畸形的效果。方法回顾性病例系列分析。收集解放军总医院眼科医学部眼眶病外科2018年1月至2021年10月收治的眼眶血管畸形并接受博来霉素灌洗联合氰基丙烯酸异丁酯胶栓塞术患者的临床资料。按术前有无体位性眼球突出分为扩张型组和非扩张型组, 比较两组的基线资料和随访时间、病程、博来霉素及氰基丙烯酸异丁酯胶的用量、术前与术后视力、影像学表现、组织病理学结果和缓解率。统计学分析主要采用χ^(2)检验, Wilcoxon符号秩检验和Mann-WhitneyU检验。结果共纳入患者58例(58只眼), 其中男性22例(37.9%), 女性36例(62.1%);扩张型组19例(32.8%), 非扩张型组39例(67.2%)。扩张型组年龄大于非扩张型组[39.0(28.0, 54.5)和14.0(5.7, 26.5)岁, Z=-3.96, P<0.001)], 两组性别、眼别、随访时间差异均无统计学意义(均P>0.05)。扩张型组病程长于非扩张型组[120(12, 240)和12(1, 90)个月, Z=-2.50, P=0.013]。术中博来霉素用量:扩张型组1.5(1.4, 1.5)万U, 非扩张型组1.5(0.9, 1.6)万U;氰基丙烯酸异丁酯胶用量:扩张型组2.8(1.0, 3.0)ml, 非扩张型组1.7(1.0, 2.2)ml。两组博来霉素和氰基丙烯酸异丁酯胶的用量差异均无统计学意义(Z=-0.70, P=0.944;Z=-1.11, P=0.268)。两组均未发生视力下降或丧失, 非扩张型组视力提高5例。影像学检查结果显示, 扩张型组治疗前后畸形血管最大面积分别为384.0(329.0, 458.0)和330.5(271.6, 356.7)mm^(2), 差异无统计学意义(Z=-1.26, P=0.208)。非扩张型组治疗前后畸形血管最大面积分别为960.8(822.1, 1058.3)和311.6(164.6, 361.6)mm^(2), 差异有统计学意义(Z=-2.67, P=0.008)。所有患者均未出现明显局部或全身不良反应。扩张型组获得组织标本15例, 病理学检查结果均符合血管畸形;非扩张型组获得组织标本39例, 其中病理学检查结果符合血管畸形41.0%(Objective To evaluate the clinical efficacy of bleomycin lavage combined with N-butyl-2-cyanoacrylate glue embolization and resection in the treatment of orbital vascular malformations.Methods It was a retrospective case series study.Patients with orbital vascular malformations diagnosed at the Ophthalmology Division of Chinese PLA General Hospital from January 2018 to October 2021 were included and divided into exophthalmos group and non-exophthalmos group based on whether the patients had postural exophthalmos.Intralesional bleomycin injection and N-butyl-2-cyanoacrylate glue embolization were performed.The preoperative and postoperative visual acuity,the dosages of bleomycin and isobutyl cyanoacrylate glue,pathological results,imaging findings and remission rate were recorded and analyzed.The Chi-square test,Wilcoxon signed rank analysis and Mann-Whitney U test were used for statistical analysis.Results A total of 58 patients(58 eyes)were included,and there were 22 males(37.9%)and 36 females(62.1%).Nineteen(32.8%)patients had postural exophthalmos,and 39(67.2%)patients did not suffer postural exophthalmos.The patient's age of the two groups was 39.0(28.0,54.5)years vs.14.0(5.7,26.5)years,with a statistically significant difference(Z=-3.96,P<0.001).There was no significant difference in gender,eye laterality,follow-up time and the disease course between the two groups(all P>0.05).During the operation,the dosage of bleomycin was 15000(13500,15000)U in the exophthalmos group,and 15000(9000,16500)U in the non-exophthalmos group(Z=-0.70,P=0.944).The dosages of N-butyl-2-cyanoacrylate glue were 2.8(1.0,3.0)ml and 1.7(1.0,2.2)ml,respectively,in the two groups,with no significant difference(Z=-1.11,P=0.268).There was no visual impairment in both groups,while the visual acuity in 5 patients without postural exophthalmos was improved postoperatively.The imaging examination results showed no difference in the malformed vascular area before and after the treatment in the exophthalmos group[384.0(329.0,458.0)mm^(2)vs.330.5

关 键 词：眶疾病 血管畸形 博来霉素 恩布酯 胶剂 灌洗疗法 栓塞 治疗性 治疗结果 

分 类 号：R779.6[医药卫生—眼科]