经皮硬化疗法治疗手部静脉畸形37例

Percutaneous sclerotherapy for the treatment of venous malformations of hand: clinical results in 37 patients

目的评价经皮硬化治疗手部静脉畸形的疗效及安全性。方法回顾性分析2010年10月至2017年6月收治的37例临床诊断为手部静脉畸形患儿临床资料。其中男16例,女21例;年龄3个月~15岁,平均(3.4±1.3)岁。所有患儿术前均经影像学诊断,术中穿刺造影进一步证实。全身麻醉下蝶形针穿刺病灶,回抽静脉回血并DSA造影确定瘤巢,注入聚多卡醇泡沫或无水乙醇硬化剂至瘤巢完全填充或引流静脉显示。术后1、3、6、12、24个月随访临床症状及影像学检查,评价治疗效果及并发症发生。结果术后随访6~32个月,平均25±7个月。37例患儿共接受92次(1~8次/例,平均2.5次/例)治疗,其中单纯无水乙醇注射21例,聚多卡醇泡沫硬化10例,联合应用6例。治愈15例(40.5%),缓解20例(54.1%),无缓解2例(5.4%)。术后患儿均有肿物肿胀,2例局部破溃(5.4%),1例(2.7%)末节食指坏死行截指,均无手部活动障碍、神经损伤及强直畸形等并发症发生。结论经皮硬化疗法是微创治疗手部静脉畸形的安全有效方法,但无水乙醇硬化剂应用时应谨慎。

Objective To evaluate the clinical efficacy and safety of percutaneous sclerotherapy in treating venous malformations of hand. Methods The clinical data of 37 sick children with clinically-diagnosed venous malformations of hand, who were admitted to Guangzhou Municipal Medical Center for Women and Children, Guangzhou, China, to receive treatment, were retrospectively analyzed. The sick children included 16 male sick children and 21 female sick children, with a mean age of（3.4±1.3） years old（ranging from 3 months to 15 years old）. The diagnosis was confirmed with imaging examination before treatment and was further proved by intraoperative puncture radiography. Under general anesthesia, puncture of the lesion was performed with a butterfly needle, then venous blood was drawn and angiography with DSA was followed so as to determine the location of the lesion nidus, which was followed by the injection of sclerosing agent, the polycarol foam and/or ethanol, until the lesion nidus was complete filled or the draining vein was visualized. The patients were followed up at one, 3, 6, 12 and 24 months after the treatment to check their clinical symptoms and imaging manifestations. The curative effect was evaluated and the occurrence of complications was analyzed. Results The patients were followed up for 6-32 months, with a mean of（25 ±7） months. A total of 92 times of percutaneous sclerotherapy were carried out in 37 sick children, with an average of 2.5 times per sick child（varying from one to 8 times per sick child）. Simple ethanol injection was employed in 21 sick children, injection of polycarol foam was adopted in 10 sick children, and combination use of both ethanol and polycarol foam was conducted in 6 sick children. Cure of the lesion was achieved in 15 sick children（40.5%）, remission of the lesion was obtained in 20 sick children（54.1%）, and no response was seen in 2 sick children（5.4%）. After sclerotherapy, swelling of lesion was observed in all sick children, 2 sick children（5.4%） developed local ulceration, and one sick child（2.7%）had to receive surgical resection of the distal phalanx of index finger due to phalanx necrosis. No complications such as hand dyskinesia, neurologic damage or ankylosis deformity occurred. Conclusion For the treatment of venous malformations of the hand, percutaneous sclerotherapy is minimally-invasive, safe and effective. However, extra carefulness should be taken in the performance of percutaneous sclerotherapy when ethanol is used as a sclerosing agent.