超声引导在混合硬化治疗低流量脉管畸形中的应用价值

Value of Ultrasonic Guidance in Treatment of Low Flow Vascular Malformations with Mixed Sclerosis

目的探讨超声引导混合硬化治疗低流量脉管畸形的应用价值。方法回顾性分析2013年5月至2017年12月收治的186例脉管畸形患者的资料。病灶部位:下肢占34.9%,头面颈部占19.9%,上肢和脚踝占11.3%。病变大小:直径<5cm 78例,直径≥5cm 108例。治疗过程主要采用超声引导,必要时结合透视监控注射泡沫硬化剂。根据主观症状改善状况和Achauer标准进行疗效评估,并比较不同病变部位、病灶直径的疗效。结果 186例患者均顺利完成手术,临床治愈率为46.8%(87/186),有效率为47.8%(89/186),无效率为5.4%(10/186),总有效率为94.6%(176/186)。术中未见胸痛、过敏性休克等并发症;每位患者完成治疗次数1～5次,平均(1.8±0.3)次。不同病变部位患者的疗效比较差异无统计学意义(P>0.05);与病灶直径≥5cm的患者比较,病灶直径<5cm患者总有效率(100.0%比90.7%,χ2=5.921、P=0.015)更高,治疗次数[(1.2±0.3)次比(2.5±1.5)次,t=7.541、P<0.001]更少。结论超声在术前能明确诊断低流量脉管畸形,术中超声引导结合透视监控混合硬化治疗可提高治疗准确性,减少并发症,且对病灶直径<5cm的脉管畸形治愈效果更好。超声对低流量脉管畸形患者术前手术方案的制定、手术的实施以及术后随访有着重要作用。

Objective To explore the value of ultrasound-guided mixed sclerosis in the treatment of low flow vascular malformations.Methods Data of 186 patientstreated from May 2013 to December 2017 for vascular malformations were analyzed retrospectively.The malformations were mainly distributedin lower limbs(34.9%),head,face and neck(19.9%),and upper limbs and ankles(11.3%).Thediameter of lesions was<5 cm in 78 cases,and≥5 cm in 108 cases.Ultrasound-guided injection was performedduring the treatment,and the combination of fluoroscopy and sclerosing foam injection was used when necessary.The curative effect was evaluated according to subjective symptom improvement and Achauer standard.Results All patients successfully completed the operation.The clinical cure rate,effective rate and ineffective rate were 46.8%(87/186),47.8%(89/186),5.4%(10/186)and 94.6%(176/186),and 94.6%(176/186)respectively.No chest pain,an aphylactic shock and other complications were observed during operation.Patients were treated 1-5 times(average,(1.8±0.3)times).There was no significant difference in the curative effect between patients with different lesions(P>0.05).Compared with patients with lesiondiameter≥5cm,patients with lesiondiameter<5cm had increased total effective rate(100.0%vs 90.7%)and decreased treatment times((1.2±0.3)times vs(2.5±1.5)times)(P<0.05).Conclusion The ultrasound can clearly diagnose low flow vascular malformations before operation.Intraoperative ultrasound guidance combined with fluoroscopy monitoring and mixed sclerotherapy for vascular malformations can improve the accuracy of treatment and reduce complications,especially forlesions with diameter<5cm.The ultrasound plays an important role in the formulation of operative plan,implementation of surgery and postoperative follow-up in patients with low flow vascular malformations.