无水乙醇联合聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形的临床研究

Clinical study on sclerotherapy using absolute ethanol combined with polidocanol injectable foam in treatment of venous malformation in maxillofacial region of children

目的:探讨DSA引导下经皮无水乙醇联合聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形的临床疗效。方法:收集我院2015年9月—2016年7月全麻下介入硬化治疗的68例儿童颌面部静脉畸形患儿的临床资料,根据临床及影像学表现,将颌面部静脉畸形分为高回流型与低回流型,其中21例属于高回流型,47例属于低回流型。高回流静脉畸形术中均使用无水乙醇联合3%聚多卡醇泡沫进行硬化治疗;低回流静脉畸形采用3%聚多卡醇泡沫或联合无水乙醇进行硬化治疗。术后随访6~15个月,平均10个月。结果:47例低回流型静脉畸形中治愈9例,基本治愈23例,有效15例,无效0例,有效率100%;21例高血流型静脉畸形中治愈0例,基本治愈6例,有效14例,无效1例,有效率为95.2%(20/21);68例患儿总有效率为98.5%(67/68)。不良反应:211例次介入硬化治疗中,189例次术后病灶处明显肿胀,33例次病灶处皮肤起水泡,25例次术后低热,对症治疗后明显缓解;2例注射无水乙醇后出现血氧急剧下降、心率下降等肺动脉高压症状,积极治疗后症状消失。皮肤破溃1例,对症治疗2月后皮肤愈合。无发生过敏反应、异位栓塞与神经损伤病例。结论:无水乙醇联合3%聚多卡醇泡沫硬化治疗儿童颌面部静脉畸形是一种安全、有效及并发症小的治疗方法。

Objective： To evaluate the clinical efficacy of sclerotherapy using absolute ethanolcombined with 3% polidocanol injectable foam in treatment of venous malformation in maxillofacial region of children. Methods： Totally 68 patients with venous malformation were treated by sclerotherapy under general anesthesia from September 2015 to July 2016. All cases were classified as two types such as fast-flow and low- flow venous malformation according to local puncture angiography. 21 cases with fast-flow venous malformations were treated by sclerotherapy using absolute ethanol and 3% polidocanol injectable foam, 47 cases with low- flow venous malformations were treated by sclerotherapy using 3% polidocanol injectable foam or with absolute ethanol. They were followed up for 6 to 15 months with an average of 10 months. The therapeutic effects and side effects were observed. The clinical evaluations were divided into four categories： cured, basic cured, effective and ineffective. Results ： 47 cases of low -flow venous malformation were treated successfully, 9cases were cured, 23 cases were basically cured, 15 cases were effective, and the total effective rate was 100%. 21 cases of fast -flow venous malformation were treated successfully, 6 cases were basically cured, 14 cases were effective, 1 case was ineffective, and effective rate was 95.2% （20/21）. The total effective rate of two types was 98.5% （67/68）. Adverse reactions： postoperative complications included transient swelling in 189 cases, blisters formed in 33 cases and lower fever in 25 cases among 211treatments, and the symptoms were relieved obviously after symptomatic treatment. Pulmonary arterial hypertension symptoms such as rapid decline in blood oxygen and heart rate decreased after injection ofabsolute ethanol in 2 cases, and the symptoms disappeared after positive treatment. Skin ulceration ap-peared in one case, and the skin was cured after special therapy for 2 months. There was not any case with allergic reaction, ectopic embolism or nerve injury. Conclusions： Sclerotherapy using absolute ethanol combined with 3% polidocanol injectable foam is an effective and safe method with few side effect for the treatment of venous malformations in children.