海绵状血管瘤内压监测指导栓塞及硬化剂注射治疗

Study on intravaseular pressure change during sclerotherapy for cavernous hemangiomas(CHs)

为探讨在栓塞硬化海绵状血管瘤中瘤腔内压变化规律及其意义,在29例治疗过程中结合机械性减缓瘤体静脉回流,进行了瘤腔内压连续监测。发现:瘤腔基础内压为0.667～2.0kPa(1kPa=7.5mmHg),颈部最低;回流快者所需栓塞次数多,用量大;瘤腔内压力曲线在栓塞初始为平台波形,提示回流静脉逐一被栓塞;随后出现缓慢下降的钝峰波形,去除瘤体体表浅回流静脉机械性压迫,瘤腔内压不变,提示回流静脉全部栓塞,可注射硬化剂;最后为快速下降的锐峰波形,表明全瘤体已被栓塞硬化。治疗29例,随访半年至3年,26例完全消退,3例复发,未见严重并发症。本法设备操作简便,疗效高,并发症少。

To investigate the regulation and significance of the intravascular pressure change of cav- ernous hemangiomas during the treatment of sclerotherapy,we did observations in 29 cases with slowing down the efferent blood flow of the CHs in their treatment.It was found that the baseline intravascular pressure of CHs is 5～15 mmHg,the lowest being at the neck.The efferent rate of CHs is higher than the afferent rate.The higher the efferent rate,the more times of injection and more amount of thrombo- tic agent were needed.At the beginning of the thrombosis,the CHs pressure rose gradually to a flat curve,which suggested that the efferent veins were being thrombosed one by one.Then the CHs pres- sure curve became a blunt peak,which suggested that all the efferent veins were thrombosed and it was time to inject the sclerosing agent.Finally the CHs pressure curve became a sharp peak,suggesting that the whole CHs was thrombosed and sclerosed.Follow-up from 6 months to 3 years revealed that CHs disappeared in 26 of 29 cases,recurred in 3 cases.No severe complications were found.The authors con- cluded that the treatment can improve the curative effect and decrease complications.