DSA引导下半导体激光联合聚多卡醇治疗儿童静脉畸形的临床观察

Application of Semiconductor Laser Combined with Polidocanol under the Digital Subtraction Angiography for the Treatment of Venous Malformations in Children

目的评价在DSA引导下联合应用940 nm半导体激光和聚多卡醇治疗儿童静脉畸形的有效性与安全性。方法2016年8月至2017年5月,采用940 nm半导体激光联合聚多卡醇治疗静脉畸形患儿57例。所有患儿均在DSA影像引导下接受至少1次的联合治疗。术后3个月MRI复查,依据病灶的消退情况评价疗效。结果 57例静脉畸形患儿共进行了89次的联合硬化治疗(平均为1.56±0.12次)。治愈12例,有效42例,无效3例。治愈率为21.05%,总有效率为94.74%。24例患儿在治疗后出现治疗部位肿胀,未给予特殊处理,术后2周内自行消退。17例患儿出现治疗部位疼痛感,术后24 h内消失。3例患儿治疗后局部出现水泡,2例在2周内吸收,1例出现局部破溃,局部换药2周后愈合,遗留局部浅表瘢痕。结论 DSA引导下半导体激光联合聚多卡醇治疗儿童静脉畸形是安全有效的治疗方式。特别对于具有引流静脉的病灶,通过半导体激光精确阻断,使其转换为局限型病灶后,再行进一步的联合治疗,能够增强单次治疗效果,减少治疗次数。

Objective To evaluate the effectiveness and safety of combined application of semiconductor laser and polidocanol under the digital subtraction angiography（DSA） for the treatment of venous malformations in children. Methods From August 2016 to May 2017, totally 57 patients of VMs were treated by semiconductor laser combined with polidocanol.All patients diagnosed as VM according to MRI examination and evaluation by 2 experienced physicians. All patients accepted at least once combined therapy and all the treatment were finished under the DSA. Three months after the therapy,all patients got MRI re-examination. The effectiveness is evaluated by the improvement of the lesions. Results Totally 89 times combined therapy were performed, average 1.56 ±0.12 times per child. Twelve patients were cured and 42 children got improvement of the lesion or their clinical symptoms. Three patients did not achieve any improvement. The cure rate was21.04% and the total efficiency rate was 94.74%. The main side effects were swelling, pain and bubble. Twenty-four children appeared a local swelling of the lesion region after treatment, and improved spontaneously. Seventeen patients felt painful after the treatment and regressed in 24 hours after the treatment finished. Three children appeared a bubble at the therapy location, 2 patients regressed after 2 weeks without any special treatment, but one child appeared a secondary ulcer after the bubble was ruptured. Although the ulceration was healed after 2 weeks ＇ wound nursing, but the scar was left inevitably. Conclusion The combined application of semiconductor laser and polidocanol under the DSA for the treatment of venous malformations in children is safe and effective. Especially in those children who have draining veins in their lesions, the therapy is helpful in improving the therapy efficiency and reduce the treatment times.