无水乙醇及平阳霉素硬化治疗静脉畸形的并发症分析

Analysis of the complications of the sclerotherapy for venous malformation using anhydrous ethanol and pingyangmycin

目的：分析无水乙醇及平阳霉素硬化治疗静脉畸形的并发症，探讨并发症发生的原因及防治措施。方法：利用经皮技术直接穿刺进入扩张静脉血窦，先注射无水乙醇进行回流静脉栓塞，然后加用平阳霉素注射治疗静脉畸形，术后随访12～60个月，对出现的相关并发症进行分析，探讨其发生原因及预防治疗措施。结果：本组患者96例，总计治疗274次，94例有效（97.9%），2例（2.1%）无改善。与无水乙醇相关的并发症包括：局部疼痛、肿胀普遍出现，8次（2.9%）出现组织坏死，10次（3.6%）出现水疱，4次(1.5%)出现周围神经麻痹，12次(4.4%)出现色素沉着，1次(0.35%)出现足底肌腱挛缩；1次(0.35%)遗留较大的硬结难于消退；34次(12.4%)出现平阳霉素所致的一过性发热或恶心、食欲不振，症状均在术后2d内消失；本组未发现严重并发症如心肺衰竭、深静脉栓塞、肺栓塞或肺纤维化。结论：无水乙醇及平阳霉素硬化治疗静脉畸形有效率高，并发症大多数可以接受，并可恢复，无严重并发症发生，是一种安全可靠，疗效确切的治疗方法。

Objective The aims of this study were to analyze the complications of the sclerotherapy for venous malformationusing anhydrous ethanol and pingyangmycin, to investigate the causes of the complications, and to discuss the preventiveand therapeutic measures for the complications. Methods Percutaneous sclerotherapy was performed by direct injectionof anhydrous ethanol into the expansive venous sinus to induce embolization of the draining vein and, subsequently, further injection of pingyangmycin. The post-operative follow-up ranged from 12 to 65 months. The complications, causes, preventiveand therapeutic measures were comprehensively explored. Results The study cohort was comprised of 96 patients with a sumof 274 times of sclerotherapy. The treatment was effective in 94 cases (97.9%), while 2 cases (2.1%) showed no improvement.The complications related to injection of anhydrous ethanol included: common occurrence of local pain and swelling; 8instances (2.9%) of tissue necrosis;10 instances(3.6%)of blistering;4 instances (1.5%) of peripheral nerve palsy; 12 instances(4.4%) of pigmentation; 1 instance (0.35%) of foot tendon contracture; 1 instance (0.35%) of large scleroma (which wasresistant to disappear). The complications related to injection of pingyangmyc inincluded 34 instances (12.4%) of transientfever, nausea, or loss of appetite (these syndromes all disappeared within 2 post-operative days). No serious complications,such as cardiopulmonary collapse, deep vein thrombosis, pulmonary embolism and pulmonary fibrosis, were observed in thisstudy. Conclusion The sclerotherapy for venous malformation by a combination of anhydrous ethanol and pingyangmycin ishighly effective. Most complications are acceptable, and can be rehabilitated. No serious complications occurred. The reportedsclerotherapy is a safe, reliable, effective treatment.