静脉畸形血管内治疗的疗效和安全性评价

Endovascular Therapy of Venous Malformations:Evaluation of Safety and Efficacy

目的评价血管内治疗静脉畸形的疗效和安全性。方法在我科接受治疗的211例静脉畸形患者,根据术前MRI特征分为局限型和侵润型。其中局限型122例,侵润型89例。均经皮直接穿刺,注入无水乙醇,栓塞病灶回流静脉,然后注入博来霉素A5。术后随访12～69个月。结果 211例中有效206例(97.63%),其中60例(28.43%)症状消失,48例(22.75%)接近正常,62例(29.38%)明显好转,36例(17.06%)轻微好转,5例(2.37%)无改善。本组患者总计治疗628次,6次出现组织坏死,5次出现周围神经麻痹,10次出现色素沉着,5次出现水疱,113次出现博来霉素所致的一过性发热或恶心、食欲不振。上述所有并发症均未给予特殊治疗,均自行愈合。本组未见严重并发症,如心肺衰竭或肺纤维化发生等。结论血管内治疗静脉畸形是安全、有效的,可成为静脉畸形的主要治疗手段。

Objectives To evaluate endovascular therapy for venous malformations and its safety and efficacy of the treatment.Methods Six hundred and twenty eight sclerotherapy sessions were performed on 211 patients,aged 2-54 years（mean,14.5 years）.There were 104 females and 107 males.All patients had a pre-procedure magnetic resonance imaging（MRI） study.Lesions were categorized as limited venous malformations and infiltrating venous malformations on the basis of MRI feature.Percutaneous endovascular therapy by direct injection was performed.After embolization of drainage vein with absolute ethanol,the following Bleomycine was injected.Results All patients were followed up for 12 months to 69 months with an average of 43 months.According to major symptoms,the results were excellent in 60 cases,good in 42 cases,fair in 62 cases and poor in 1 case.The better response was among the patients with limited venous malformations.Among of them 116 cases（95%） showed at least marked improvement.There were 6 sessions of tissue necrosis,5 sessions peripheral nerve palsy,10 sessions pigmentation,5 sessions blistering,and 89 sessions transient side effects related to Bleomycine such as fever and gastrointestinal irritation.No major complications such as cardio-pulmonary collapse and pulmonary fibrosis were reported.Conclusion Endovascular therapy for venous malformations was found to be safe and effective,which may be one of the techniques in the treatment of venous malformations.