尿素注射联合手术治疗手部静脉畸形

Combined treatment with urea injection and surgical correction for venous mafformafions of the hand

目的探讨尿素联合手术治疗手部静脉畸形的疗效和安全性。方法回顾性分析46例手部静脉畸形患者的病例资料，术前病变部位局部多点多层注射质量分数为40％的尿素溶液，每日注射一次，注射量为2—5ml，7d为一个疗程，停药1d后行手术治疗。术后评价瘤体变化情况，追踪随访，评价复发率。结果39例一期手术切除，未见复发；5例行二期手术完全切除；2例病变累及整个手部，仅针对有明显疼痛的病变进行手术切除，术后每3个月行尿素硬化剂溶液注射治疗，控制瘤体生长，疼痛缓解，症状较前改善。结论尿素联合手术，既可硬化瘤体，控制瘤体生长，又可减少术中出血，使术中界限清晰，更有助于完整地切除瘤体，并能早期解除患者的疼痛，恢复手部的正常功能，是治疗手部静脉畸形的有效方法。

Objective To investigate the safety and eificacy of urea injection combined with surgery for treatment of venous malformation of the hand. Methods A retrospective analysis was conducted of 46 cases of venous malformations in the hand. Preoperatively multipoint and multilayer injection of urea solution with a mass fraction of 40% was administered daily to the pathologic sites. The volume of the injection is 2 to 5 ml. The duration of the injection was 7 days followed by one day of withdrawal before the surgery. Postoperatively remission of the tumors was evaluated and the patients were followed up to assess the recurrence rate. Results Thirty-nine cases had one stage surgical resection with no recurrences. A second surgery was required in 5 cases to completely remove the malformations. In 2 cases where the lesions involved the entire hand, only lesions with obvious pain were surgically resected, supplemented by injections of sclerotic agents every 3 months that led to control of tumor growth, pain relief, and alleviation of the symptoms. Conclusion Urea injection is an effective adjunct to surgical resection. It controls tumor growth, hardens the tumors and provides cleat demarcation of the tumors all of which can reduce intraoperative bleeding and facilitate complete removal of the tumors. It leads to early pain relief and restoration of normal hand function. It is an effective method for treatment of venous malformations of the hand.