单纯铜针留置和铜针留置结合环形缝扎治疗脉管畸形

Indwelling copper needle alone,indwelling copper needle combined with ring suture technique for the treatment of vascular malformations

目的:探讨并总结铜针留置、铜针留置结合环形缝扎治疗脉管畸形的临床应用体会。方法:采用铜针留置、铜针留置结合环形缝扎治疗脉管畸形患者46例,其中静脉畸形43例,动、静脉畸形3例。治疗1～3次,其中第1次治疗41例,第2次治疗4例,第3次治疗1例,再次治疗至少间隔6个月。观察铜针留置治疗后患者的局部和全身反应,检测其中6例患者铜针留置治疗前及铜针留置治疗5天后血清铜及肝功能变化,数据结果进行统计学分析并对疗效进行评价。结果:本组治疗患者46例,术后随访6～24个月。临床治疗效果:I级(差)3例,占6.5%;II级(中)11例,占23.9%;III级(好)27例,占58.7%;IV级(优)5例,占10.9%。43例(包括中、好和优)脉管畸形患者获得有效治疗(图2～3),总有效率为93.5%。6例留置铜针治疗5天后,血清铜轻度升高,方差分析显示与治疗前相比无显著性差异(P>0.05);血清丙氨酸氨基转移酶、谷草转氨酶活性轻度升高,秩和检验显示与治疗前相比无显著性差异(P>0.05)。结论:铜针留置简单易行、安全性高,对患者组织形态和功能影响小,是治疗脉管畸形的有效方法之一;铜针留置结合环形缝扎是铜针治疗脉管畸形的改进和发展,可以更有效地治疗脉管畸形,适用于治疗病变范围较大、较深的脉管畸形。

Objective To explore and summarize clinical experiences for the treatment of vascular malformations by use of indwelling copper needle alone, indwelling copper needle combined with ring suture technique. Methods Forty-six patients with vascular malformations were reviewed in this study. These patients consisted of 32 females and 14 males ranging in age from 12 to 56 years. Of the 46 cases, 43 cases were venous malformation;3 cases were arteriovenous malformation. The position of the vascular malformations was as follows： 34 cases in the face and neck, 6 cases in the upper limb, 4 cases in the lower limb, 2 cases in the trunk. Two methods were selected for the treatment, respectively： （1）Indwelling copper needle alone; This method was applied to 35 cases. （2）Indwelling copper needle combined with ring suture. This method was applied to 11 cases. Treatment was one to three times,which first treatment 41 cases, second treatment 4 cases, third treatment 1 case, again treatment at least six months apart. During the indwelling copper needle, all the patients were observed for the general and local reactions. Before and 5 clays after indwelling copper needle, concentration of serum copper and hepatic function were measured in six patients; Statistical analysis was used for comparison of the results. All patients were followed up from 6 to 24 months. The criteria for curative effects were evaluated based on improvement of volume, color, and texture of vascular malformation by the following scale：（1）poor（0 to 25 percent）; （2）fair（26 to 50 percent）; （3）good（51 to 75 percent）; and （4）excellent（76 to 100 percent）. Results Therapeutic effects are divided into 4 categories： （1）poor： There were 3 cases （which account for 6.5%）. （2）fair： There were 11 cases（23.9%）. （3）good： There were 27 cases（58.7%）.（4） excellent： There were 5 cases（10.9%）. Forty- three patients with vascular malformation were effectively treated（Figs.2 to 3）. The effective rate（fair, good and excellent） was 95.5%. There were no obvious toxic reactions in these patients. After indwelling copper needles for 5 days, the concentration of serum copper increased slightly, without statistical significance compared with that before treatment （P 〉0.05）; The content of alanine aminotransferase and aspartate aminotransferase all increased slightly, without statistical signifince. （P 〉 O .05） These. results are shown in Table 1. Table 2. and Table 3. Conclusion Indwellino coDoerneedle will not induce prominent increase of serum copper or toxic reactions of copper, and it is a simple, safe, and effective treatment for most of vascular malformations without obvious damaging of tissue morphology and function of patients. Indwelling copper needle combined with ring suture technique is the approach of development and improvement, can be more effective treatment for vascular malformations, apply to the treatment of larger and deeper vascular malformation.