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

Comparative study of sclerotherapy of venous malformation in children using absolute ethanol and pingyangmycin

目的比较无水乙醇碘油混合液与平阳霉素碘油混合液介入硬化治疗儿童静脉畸形的疗效和安全性。方法2009年2月至2011年5月期间，对80例临床诊断为静脉畸形的患儿进行全麻下介入硬化治疗。80例患儿按照数字表法随机分为A、B组，每组40例。A组行无水乙醇碘油混合液治疗，B组行平阳霉素碘油混合液治疗。术后随访6—24个月，比较两组疗效及不良反应的发生率。疗效评价分为4级：治愈、基本治愈、有效、无效，治愈、基本治愈、有效的总例数为治疗有效例数。两组患儿的有效率和不良反应发生率采用x。检验比较。结果A组治疗有效率为95．0％（38／40），B组治疗有效率为65．0％（26／40），差异有统计学意义（χ^2=11．25，P〈0．01）。不良反应：A组8例皮肤破溃、4例瘤体肿胀、2例肌肉纤维化、1例并发脑梗死；B组2例术后出现发热及呕吐，2例皮肤破溃，两者不良反应发生率差异有统计学意义（χ^2=12．29，P〈0．01）。结论无水乙醇治疗儿童静脉畸形较平阳霉素疗效好，但不良反应发生率较高，其中以皮肤破溃较多见，甚至可造成严重的不良反应如脑梗死。

Objective To evaluate and compare the curative effect and the safety of selerotherapy of venous malformation in children using absolute ethanol and pingyangmycin. Methods Eighty children with venous malformation were treated by sclerotherapy with absolute ethanol or pingyangmyein under general anesthesia during February of 2009 to May of 2011. Diagnostic criteria included the presence of a bluecolored lesion at birth, with gradual increase in its size associated with a positive postural test. MRI showed characteristic imaging features. Eighty patients were divided into two groups by randomization. Forty patients were treated with absolute ethanol, and the remaining 40 patients with pingyangmycin. The therapeutic effects and side effects were observed and recorded during a follow-up period of 6 to 24 months （average 15 months）. Treatment results were divided into four categories： cure, basic cure, effective, and ineffective, and the former three categories were considered effective in treatment. Chi-square test was used to compare the rate of effective treatment and rate of complications in these two groups. Results The effective patients treated with absolute ethanol was 38 （95.0% ,38/40）, and the effective patients with pingyangmycin was 26（65.0% ,26/40）, χ2 test （ χ2 = 11.25, P 〈 0.01 ） difference was statistically significant. Eight patients developed skin necrosis; 4 patients serious local swelling, 2 patients muscle fibrosis, 1 patient cerebral embolism in the absolute alcohol group. Two patients developed postoperative fever and vomiting and 2 skin necrosis in the pingyangmycin group, the difference was statistically significant （χ2 = 12.29, P 〈 0.01 ）. Conclusions Sclerotherapy is effective for the treatment of venous malformations in children. Absolute ethanol is more effective, but associated with more complications, such as skin necrosis or as serious as cerebral embolism, than pingyangmycin.