硬化剂治疗头颈部静脉畸形临床疗效及作用机制研究

The utilization of hardening agent for the treatment of cephalocervical venous malformations: study of its clinical efficacy and mechanism

目的探讨聚桂醇泡沫硬化剂、无水乙醇治疗头颈部静脉畸形的临床疗效及作用机制。方法总结分析福建医科大学附属协和医院2012年3月至2014年3月住院治疗的71例静脉畸形患者共82病灶,分为A组(n=40,接受聚桂醇泡沫硬化剂治疗)和B组(n=42,接受无水乙醇注射治疗)。A组中高回流型病灶23个(A1组),低回流型病灶17个(A2组);B组中高回流型病灶25个(B1组),低回流型病灶17个(B2组)。对比分析A、B两组以及A1、A2组,B1、B2组,A1、B1组,A2、B2组临床疗效,并记录术后不良反应情况。结果 A组、B组总有效率分别为70.0%、95.2%(P<0.05),A1组、A2组总有效率分别为56.5%、88.2%(P<0.05),B1组、B2组总有效率分别为92.0%、100%(P>0.05);A1组、B1组有效率间差异有统计学意义(P<0.05),A2组、B2组有效率间差异无统计学意义(P>0.05)。结论无水乙醇硬化治疗头颈部静脉畸形较聚桂醇泡沫硬化剂更有效,其主要机制在于能更彻底地栓塞回流静脉;聚桂醇泡沫硬化剂治疗安全、不良反应少,对低流速型静脉畸形有较好疗效。

Objective To investigate the clinical efficacy and mechanism of polyvinyl alcohol foam hardening agent （lauromacrogol） and ethanol, used as hardening agents, in treating cephalocervical venous malformations. Methods A total of 71 patients with cephalocervical venous malformations （82 lesions in total）, who were admitted to the Affiliated Union Hospital of Fujian Medical University during the period from March 2012 to March 2014 to receive sclerotherapy, were enrolled in this study. The patients were divided into group A （n=40, receiving lauromacrogol therapy） and group B （n=42, receiving ethanol injection therapy）. Based on the amount of venous return blood flow of the lesion, the lesions in group A were subdivided into subgroup A1 （high venous return type, n=23） and subgroup A2 （low venous return type, n= 17）, and the lesions in group B were also subdivided into subgroup B1 （high venous return type, n=25 ） and subgroup B2 （low venous return type, n=17）. The clinical effects were compared between group A and group B, between subgroup A1 and subgroup A2, between subgroup B1 and subgroup B2, between subgroup A1 and subgroup B1, as well as between subgroup A2 and subgroup B2. The postoperative adverse reactions were recorded. Results The total effective rates of group A and group B were 70.0% and 95.2% respectively （P〈0.05） ; the total effective rates of subgroup A1 and subgroup A2 were 56.5% and 88.2% respectively （P〈 0.05） ; the total effective rates of subgroup B1 and subgroup B2 were 92.0% and 100% respectively （P〉0.05）.Statistically significant difference in the total effective rate existed between subgroup A1 and subgroup B1 （P〈 0.05）, and no statistically significant difference in the total effective rate existed between subgroup A2 and subgroup B2 （P〉0.05）. Conclusion In treating cephalocervical venous malformations with sclerotherapy, injection of ethanol is more effective than the use of lauromacrogol, as ethanol can obstruct the draining veins more thoroughly. Nevertheless, the use of lauromacrogol, which is a kind of foam hardening agent, is safe with less side effects, and lauromaerogol is more effective for venous malformations of low venous return type.