无水乙醇联合聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形的临床研究

doi:10.3877/cma.j.issn.2095-5782.2017.04.007

目的：

探讨DSA引导下经皮无水乙醇联合聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形的临床疗效。

方法：

收集我院2015年9月—2016年7月全麻下介入硬化治疗的68例儿童颌面部静脉畸形患儿的临床资料，根据临床及影像学表现，将颌面部静脉畸形分为高回流型与低回流型，其中21例属于高回流型，47例属于低回流型。高回流静脉畸形术中均使用无水乙醇联合3%聚多卡醇泡沫进行硬化治疗；低回流静脉畸形采用3%聚多卡醇泡沫或联合无水乙醇进行硬化治疗。术后随访6~15个月，平均10个月。

结果：

47例低回流型静脉畸形中治愈9例，基本治愈23例，有效15例，无效0例，有效率100%；21例高血流型静脉畸形中治愈0例，基本治愈6例，有效14例，无效1例，有效率为95.2%（20/21）；68例患儿总有效率为98.5%（67/68）。不良反应：211例次介入硬化治疗中，189例次术后病灶处明显肿胀，33例次病灶处皮肤起水泡，25例次术后低热，对症治疗后明显缓解；2例注射无水乙醇后出现血氧急剧下降、心率下降等肺动脉高压症状，积极治疗后症状消失。皮肤破溃1例，对症治疗2月后皮肤愈合。无发生过敏反应、异位栓塞与神经损伤病例。

结论：

无水乙醇联合3%聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形是一种安全、有效及并发症小的治疗方法。

关键词: 静脉畸形, 儿童, 硬化治疗, 聚多卡醇, 无水乙醇

Objective:

To evaluate the clinical efficacy of sclerotherapy using absolute ethanol combined with 3% polidocanol injectable foam in treatment of venous malformation in maxillofacial region of children.

Methods:

Totally 68 patients with venous malformation were treated by sclerotherapy under general anesthesia from September 2015 to July 2016. All cases were classified as two types such as fast-flow and low-flow venous malformation according to local puncture angiography. 21 cases with fast-flow venous malformations were treated by sclerotherapy using absolute ethanol and 3% polidocanol injectable foam, 47 cases with low-flow venous malformations were treated by sclerotherapy using 3% polidocanol injectable foam or with absolute ethanol. They were followed up for 6 to 15 months with an average of 10 months. The therapeutic effects and side effects were observed. The clinical evaluations were divided into four categories: cured, basic cured, effective and ineffective.

Results:

47 cases of low-flow venous malformation were treated successfully, 9 cases were cured, 23 cases were basically cured, 15 cases were effective, and the total effective rate was 100%. 21 cases of fast-flow venous malformation were treated successfully, 6 cases were basically cured, 14 cases were effective, 1 case was ineffective, and effective rate was 95.2% (20/21) . The total effective rate of two types was 98.5% (67/68) . Adverse reactions: postoperative complications included transient swelling in 189 cases, blisters formed in 33 cases and lower fever in 25 cases among 211 treatments, and the symptoms were relieved obviously after symptomatic treatment. Pulmonary arterial hypertension symptoms such as rapid decline in blood oxygen and heart rate decreased after injection of absolute ethanol in 2 cases, and the symptoms disappeared after positive treatment. Skin ulceration appeared in one case, and the skin was cured after special therapy for 2 months. There was not any case with allergic reaction, ectopic embolism or nerve injury.

Conclusions:

Sclerotherapy using absolute ethanol combined with 3% polidocanol injectable foam is an effective and safe method with few side effect for the treatment of venous malformations in children.

Key words: Venous malformation, Children, Sclerotherapy, Polidocanol, Absolute ethanol

图1 典型病例（男，10个月，右侧颌面部肿物10月）治疗前后表现

1	Rabe E, Pannier F. Sclerotherapy in venous malformation[J]. Phlebology，2013，28 Suppl 1:188-191.
2	Bai N, Chen Y Z, Fu Y J，et al. A clinical study of pingyangmycin sclerotherapy for venous malformation: an evaluation of 281 consecutive patients[J]. J Clin Pharm Ther，2014，39(5):521-526.
3	Lee B B, Baumgartner I, Berlien P，et al. Guideline. Diagnosis and treatment of venous malformations. consensus document of the international union of phlebology(iup): updated-2013[J]. Int Angiol,2014.
4	李海波，张靖，周少毅，等. DSA引导下泡沫硬化剂治疗儿童静脉畸形的临床观察[J].介入放射学杂志，2013(09):738-741.
5	Wassef M, Blei F, Adams D, et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies[J]. Pediatrics,2015,136(1):e203-e214.
6	Xue L, Cao R Y, Xu D P, et al. Percutaneous Treatment of Large Venous Malformations in the Oral and Maxillofacial Regions Using Electrochemical Therapy Combined With Pingyangmycin[J]. J Oral Maxillofac Surg，2015，73(7):1384-1391.
7	Aboelatta Y A, Nagy E, Shaker M，et al. Venous malformations of the head and neck：a diagnostic approach and a proposed management approach based on clinical，radiological，and histopathology findings[J]. Head Neck，2014，36(7):1052-1057.
8	Koo K S, Dowd C F, Mathes E F, et al. MRI phenotypes of localized intravascular coagulopathy in venous malformations[J]. Pediatr Radiol，2015，45(11):1690-1695.
9	Puig S, Aref H, Chigot V，et al. Classification of venous malformations in children and implications for sclerotherapy[J]. Pediatr Radiol,2003,33(2):99-103.
10	Murakami T, Ogata D, Miyano K, et al. An enlarged intramuscular venous malformation in the femoral region successfully treated with complete resection[J]. Int J Surg Case Rep,2016,21:83-86.
11	Garg S, Kumar S, Singh Y B. Intralesional radiofrequency in venous malformations[J]. Br J Oral Maxillofac Surg,2015,53(3):213-216.
12	Lee B B, Baumgartner I, Berlien P, et al. Diagnosis and Treatment of Venous Malformations. Consensus Document of the International Union of Phlebology (IUP): updated 2013[J]. Int Angiol,2015,34(2):97-149.
13	牛传强，刘珍银，张靖，等.弹簧钢圈联合无水乙醇栓塞硬化治疗复杂型静脉畸形[J].中华放射学杂志,2016,50(12):963-967.
14	张靖，李海波，周少毅，等.儿童静脉畸形介入治疗硬化剂无水乙醇与平阳霉素效果的对比研究[J].中华放射学杂志,2012,46 (4):350-353.
15	翟军，翟晓东.平阳霉素联合地塞米松治疗口腔颌面颈部静脉畸形[J].中华整形外科杂志,2012,28(3):168-171.
16	Steiner F, Fitzjohn T, Tan S T. Ethanol sclerotherapy for venous malformation[J]. ANZ J Surg,2016,86(10):790-795.
17	高阳，陈辉，金云波，等.常用硬化剂治疗静脉畸形导致神经损伤的回顾性研究[J].组织工程与重建外科杂志,2016,12(4):222-226.

[1]	张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[2]	张宝富, 俞劲, 叶菁菁, 俞建根, 马晓辉, 刘喜旺. 先天性原发隔异位型肺静脉异位引流的超声心动图诊断[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1074-1080.
[3]	韩丹, 王婷, 肖欢, 朱丽容, 陈镜宇, 唐毅. 超声造影与增强CT对儿童肝脏良恶性病变诊断价值的对比分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 939-944.
[4]	刘婷婷, 林妍冰, 汪珊, 陈幕荣, 唐子鉴, 代东伶, 夏焙. 超声衰减参数成像评价儿童代谢相关脂肪性肝病的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 787-794.
[5]	周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[6]	张红霞, 程令刚, 汪洪斌, 张巍, 张雨康, 何文. 巨大肝囊肿无水乙醇硬化治疗后胆道损伤探讨[J]. 中华医学超声杂志（电子版）, 2023, 20(05): 487-491.
[7]	米洁, 陈晨, 李佳玲, 裴海娜, 张恒博, 李飞, 李东杰. 儿童头面部外伤特点分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 511-515.
[8]	陆闻青, 陈昕怡, 任雪飞. 遗传代谢病儿童肝移植受者术后生活质量调查研究[J]. 中华移植杂志(电子版), 2023, 17(05): 287-292.
[9]	王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[10]	李芳, 许瑞, 李洋洋, 石秀全. 循证医学理念在儿童腹股沟疝患者中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 782-786.
[11]	吕垒, 冯啸, 何凯明, 曾凯宁, 杨卿, 吕海金, 易慧敏, 易述红, 杨扬, 傅斌生. 改良金氏评分在儿童肝豆状核变性急性肝衰竭肝移植手术时机评估中价值并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 661-668.
[12]	卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[13]	刘笑笑, 张小杉, 刘群, 马岚, 段莎莎, 施依璐, 张敏洁, 王雅晳. 中国学龄前儿童先天性心脏病流行病学研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1021-1024.
[14]	李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
[15]	余林阳, 王美英, 李建斌, 楼骁斌, 谢思远, 马志忠, 齐海英, 李稼. 高原地区肺炎合并右心功能衰竭体征患儿的肺动脉压力和心脏形态与功能的特征[J]. 中华临床医师杂志(电子版), 2023, 17(05): 535-544.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical study on sclerotherapy using absolute ethanol combined with polidocanol injectable foam in treatment of venous malformation in maxillofacial region of children

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical study on sclerotherapy using absolute ethanol combined with polidocanol injectable foam in treatment of venous malformation in maxillofacial region of children