DSA引导下经皮入路无水乙醇联合聚桂醇治疗头颈部高回流型静脉畸形

DSA-guided percutaneous application of ethanol sclerotherapy combined with lauromacrogol foam sclerotherapy for the treatment of hyper-backflow venous malformations

目的探讨DSA引导下经皮人路应用无水乙醇联合聚桂醇治疗头颈部高回流型静脉畸形的安全性和有效性。方法回顾性分析2012年8月至2016年6月收治的72例头颈部高回流型静脉畸形，在DSA引导下经皮穿刺硬化治疗的临床资料。根据硬化治疗方法将病例分成A、B2组，A组37例以无水乙醇结合聚桂醇进行治疗，B组35例仅以聚桂醇治疗。术后随访12-24个月，平均14．3个月，比较2组的临床效果及术后不良反应。使用SPSS19．0对数据进行统计分析，2组有效率和不良反应发生率采用矿检验，以P〈0．05为差异有统计学意义。结果A组37例，10例治愈，21例基本治愈，3例有效，3例无效，总有效率91．9％（34／37）；平均注射3．2次，每例平均使用无水乙醇13．6ml，聚桂醇泡沫硬化剂220mg。B组35例，5例治愈，15例基本治愈，4例有效，11例无效，有效率68．6％（24／35），每例平均注射次数4．8次，每例平均使用聚桂醇泡沫硬化剂322mg。2组有效率比较差异有统计学意义（x2=6．245，P〈0．05），不良反应主要有组织坏死、神经损伤、张121受限，组间比较差异无统计学意义（P〉0．05）。结论DSA引导下经皮入路应用无水乙醇结合聚桂醇治疗头颈部高回流型静脉畸形是一种安全有效、并发症较轻的硬化治疗方法。

ObjectiveTo evaluate the safety and efficacy of DSA-guided percutaneous application of ethanol sclerotherapy combined with lauromacrogol foam sclerotherapy for the treatment of hyper-backflow venous malformations. MethodsThe clinical data of 72 cases of hyper-backflow venous malformation of head and neck from August 2012 to June 2016 by DSA-guided percutaneous puncture sclerotherapy were analyzed retrospectively. Based on the method of sclerotherapy, the patients were divided into group A and B. Group A was treated with ethanol combined with lauromacrogol foam, and Group B was treated with lauromacrogol foam alone. All patients were followed up for 12-24 months （mean 14.3 months）. The curative effects and postoperative adverse responses were analyzed by comparision.SPSS 19.0 software was applied, effective rate and adverse reaction rate were examined by chi square test.P〈0.05 was considered as statistically significant. ResultsGroup A（37 cases）, cure was achieved in 10, basic cure in 21 and effective response in 3, ineffective response in 3, with a total efficiency of 91.9%（34/37）. There were 3.2 average injections. The mean dose of sclerosant foam used in each patient was 220 mg and ethanol 13.6 ml. Group B（35 cases）, cure was achieved in 5, basic cure in 15 and effective response in 4, ineffective response in 11, with a total efficiency of 68.6%（24/35）. There were 4.8 average injection times. The mean dose of sclerosant foam used in each patient was 322 mg. There was statistically significant difference in total efficiency of 2 groups （χ2=6.245, P〈0.05）. The main adverse effect were tissue necrosis, nerve injury and limitation of mouth opening. There was no statistically significant difference in adverse effect of 2 groups （P〉0.05）. ConclusionsDSA-guided percutaneous application of ethanol sclerotherapy combined with lauromacrogol foam sclerotherapy for the treatment of hyper-backflow venous malformations is safe and effective with fewer complications.This technique is especially useful for the hyper-backflow type of venous malformations.