不消退型先天性血管瘤血管造影特征分析及其临床意义探讨

Angiographic characteristics of non-involuting congenital hemangioma and their clinical significance

目的分析不消退型先天性血管瘤的血管造影特征,推测其不自行消退或治疗失败的原因。方法回顾性分析2010年6月至2016年6月期间在广州市妇女儿童医疗中心介入血管瘤科被诊断为不消退型先天性血管瘤14例患儿的临床资料,年龄为(8.1±4.4)岁,年龄范围2~15岁,均接受过介入治疗,分析其血管造影特征,并与普通婴幼儿血管瘤血管造影特征进行比较。结果14例不消退型血管瘤患儿,其血管造影特征均不同于普通婴幼儿血管瘤,10例血管造影表现为明显"肿瘤样染色",进一步超选择性动脉造影可见病灶微动静脉瘘存在,回流静脉粗大并提前显影,造影剂迅速廓清,尝试经供血动脉注入平阳霉素碘油乳剂,药物难于沉积在病灶内(我们称之为Ⅰ型表现)。10例患儿先后共行1~3次动脉栓塞术,随访半年以上,病灶未见缩小,其中2例病灶甚至还较前有所增大。4例血管造影表现为"淡薄染色"或动脉造影未见明确肿瘤染色,局部经皮穿刺病灶造影可见"树枝样"回流静脉显影,尝试经皮穿刺病灶注入平阳霉素碘油乳剂,药物很容易进入粗大回流静脉,难于沉积在病灶内(我们称之为Ⅱ型表现)。4例患儿先后共行1~3次局部硬化治疗,随访半年以上,病灶未见缩小。结论超选择性动脉造影显示不消退型先天性血管瘤血管造影特征不同于普通婴幼儿血管瘤,不消退型先天性血管瘤造影通常表现为"微动静脉瘘优势型(型)"或"静脉优势型(Ⅱ型)",因为微动静脉畸形或静脉畸形的存在或许是导致不消退型先天性血管瘤不消退或药物及栓塞治疗失败的重要原因。

Objective To explore the angiographic characteristics of non-involuting congenital hemangioma and elucidate the causes for non-involuting congenital hemangioma and a failure of traditional therapy. Methods Between June 2010 and June 2016, the clinical data of 14 infants with non-involuting congenital hemangioma were reviewed. All cases received angiography and interventional therapy. Their angiographic characteristics were analyzed by comparing with the angiographic characteristics of infantile hemangoma. Results The angiographic characteristics of 14 cases with failed treatment of propranolol, bleomycin or embolizaton were different from those of common infantile hemangiomas. Ectatic dilated vein and prominent capillary blush with microshunts were observed in 10 cases. The contrast agents or embolization agents, such as iodinated oil and polyvinyl alcohol particles, flew quickly and could not stay in lesions. Capillary blush was subtle in another 4 cases while ectatic dilated vein could be observed obviously by direct puncture angiograpy. The lesions were full of abnormal veins. Conclusions The angiographic characteristics of non-involuting congenital hemangioma are different from those of common infantile hemangioma. Non-involuting congenital hemangioma is more properly called hemangioma with microfitulae or residual venous malformation. It might be the underlying cause for non-involuting congenital hemangioma or be treated as common infantile hemangioma.