外科治疗静脉畸形术后残余静脉畸形的介入硬化治疗

Treatment of residual venous malformations after surgical resection using interventional sclerotherapy

目的探讨外科治疗静脉畸形术后残余静脉畸形的介入硬化治疗效果及其安全性。方法在我科接受介入硬化治疗的18例静脉畸形患儿，均曾行外科切除术，术后复查MRI均证实仍有部分残余病灶，其中病灶位于四肢并累及肌层6例，病灶位于膝关节或肘关节腔周围2例，病灶位于颈部且包绕颈部血管或侵入颈动脉鞘3例，病灶位于足底并侵入跖骨间隙2例，病灶位于眼眶2例，累及腮腺1例，累及直肠、乙状结肠2例，上述残余病灶外科往往难于完全切除或家属拒绝再次接受外科手术。上述患儿均在我科接受介入硬化治疗，即在数字减影血管造影仪（DigitalSubtractionAn-giography，DsA）引导下经皮直接穿刺病灶，并注入聚桂醇泡沫硬化剂或无水乙醇硬化治疗，4周后若患儿未达治愈标准可重复进行，术后随访6个月至2年。结果18例患儿共接受治疗61次，平均3．4次，术后当天出院率达85．2％（52／61）。治愈3例（16．7％）、好转15例（83．3oA）、无效0例，未出现皮肤明显坏死、神经功能损害及心脑肺严重并发症。结论介入硬化治疗外科治疗静脉畸形术后残余静脉畸形具有操作简易、住院时间短、高效且安全等诸多优点，值得在临床广泛推广应用。

Objective To evaluate the efficacy and safety of interventional sclerotherapy for re- sidual venous malformations after surgical resection. Methods 18 patients suffering from residual venous malformation after surgical resection, including 6 cases in the muscle of limbs, 2 cases in the elbow or knee region,3 cases in the neck and carotid artery scabbard region,2 cases in the metatarsal region, 2 cases in the orbit region, 1 case in the parotid gland region and 2 cases in the rectum and sigmoid colon region were reviewed. All patients had pre-procedure magnetic resonance imaging（MRI） study and confirmed residual venous malformation. The reasons for scelrotherapy were difficult redo excision and parental refusal for reoperation. Percutaneous endovascular therapy by direct injection was performed on all 18 cases in our hospital. Sclerosant foam or absolute ethanol was injected into the nidus guided by DSA. Repeat sclerotherapy was again performed if the lesion was not cured in 4 weeks. All cases were followed up from 6 months to 2 years and the clinical symptoms were observed. Results Sixty one sclerotherapy sessions were perfomed （mean of 3. 4 times）. According to major symptoms and MRI features,3 cases achieved a complete response and 15 cases achieved partial response. No major complications such as tissue necrosis,peripheral nerve palsy or cardio-pulmonary collapse were found. Conclusions Interventional sclerotherapy for residual venous malformations was found to be easy, safe,and effective. It should be widely used in the treatment of residual venous malformations.