超选择血管内栓塞治疗儿童大型血管瘤的疗效影响因素分析

Analysis of the efficacy of superselective intravascular embolization in the treatment of large hemangioma in children

目的探讨超选择血管内栓塞治疗儿童大型血管瘤对临床疗效的影响因素,为临床治疗及预后提供可靠依据。方法搜集2015年1月至2018年1月,我院行超选择瘤体动脉造影及栓塞治疗的大型血管瘤患儿85例的临床及影像资料。患儿术后随访时间3个月至1.5年。根据患儿血管瘤栓塞前后DSA造影表现[供血动脉来源、供血动脉数目及动静脉瘘(AVF)],并结合患儿年龄、瘤体大小及栓塞材料的选择及配伍,使用χ^2检验分析影响疗效的因素。结果通过对以上指标临床疗效的分析显示:(1)供血动脉来源:单一和混合供血动脉来源的有效率分别为95.3%(61/64)、66.7%(14/21),差异有统计学意义(χ^2=0.688,P<0.05)。(2)供血动脉数目:1支、2支和≥3支供血动脉的血管瘤的有效比例分别为3/3、92.6%(25/27)和85.5%(47/55),差异有统计学意义(χ^2=1.944,P<0.05)。(3)AVF:伴有AVF和不伴AVF患儿有效率分别为36.4%(4/11)、95.9%(71/74),差异有统计学意义(χ^2=0.806,P<0.05)。影响复发率的因素有:(1)年龄:≤5个月和>5个月患儿的复发率分别为33.3%(6/18)和20.9%(14/67),差异无统计学意义(χ^2=1.220,P>0.05);(2)瘤体大小:瘤体直径≤80mm和>80mm患儿复发率分别为25.5%(13/51)和32.4%(11/34),差异无统计学意义(χ^2=0.474,P>0.05);(3)碘油+博来霉素栓塞和明胶海绵+博来霉素栓塞患儿复发率分别为27.0%(10/37)和31.3%(15/48),差异无统计学意义(χ^2=0.179,P>0.05)。结论超选择血管内栓塞治疗儿童大型血管瘤疗效影响因素有:动脉瘤血供来源、供血动脉数目、伴发AVF以及患儿年龄、瘤体大小、栓塞材料的选择及配伍等。

Objective To evaluate the clinical efficacy of superselective intravascular embolization in the treatment of large hemangiomas in children, and to provide a reliable basis for the clinical treatment and to predict prognosis. Methods The clinical and imaging data of 85 children with large hemangiomas who underwent superselective angiography and embolization were collected in our hospital from January 2015 to January 2018,and followed up for 3 months to 1.5 years. According to the DSA angiography of the hemangioma [artery origin, artery number, arterio-venous fistula(AVF)], and combined with age, tumor size and the selection and compatibility of embolization materials. Using the chi-square test to analyze these indicators. Results Analysis of the clinical efficacy indicators, was shown as the following: (1) Artery origin: The total effectiveness rate of single and mixed sources was 95.3% (61/64), 66.7% (14/21) respectively. The difference was statistically significant (χ^2=0.688,P<0.05). (2) Feeding artery number: The total effectiveness rate of 1 branch, 2 branches and ≥3 branches was (3/3),(25/27)and (47/55) respectively. The difference was statistically significant (χ^2=1.944, P<0.05). (3) Presence of fistula(AVF): The total effectiveness rate of AVF and without AVF was 36.4% (4/11) and (95.9%, 71/74) respectively. The difference was statistically significant (χ^2=0.806, P<0.05). Other influencing factors including: (1)Age:the recurrence rate of patients≤5 months and>5 months was 33.3% (6/18) and 20.9% (14/67) respectively. There was no significant difference (χ^2=1.220,P>0.05); (2)Tumor size:The recurrence rate of φ≤80 mm and φ>80 mm was 25.5% (13/51) and 32.4%(11/34) respectively. There was no significant difference (χ^2=0.474, P>0.05). (3) Selection and compatibility of embolization materials: The recurrence rate of Lipiodol+bleomycin and gelatin sponge+bleomycin was 27.0% (10/37) and 31.3% (15/48) respectively. There was no significant difference (χ^2=0.179,P>0.05). Conclusions The clinical efficacy of superselective intravascular embolization in the treatment of large hemangioma in children was influenced by: artery origin(mixed sources),artery number (≥3 branches),AVF, age tumor size, selection and compatibility of embolic materials.