超声引导下聚多卡醇注射治疗儿童四肢静脉畸形的疗效分析

Polidocanol injection under ultrasonic guidance for pediatric extremity venous malformations

目的探讨超声引导下聚多卡醇注射治疗儿童四肢静脉畸形的治疗效果及并发症。方法回顾性收集2013年1月至2018年5月于电子科技大学附属四川省人民医院儿童医学中心收治的53例仅行超声引导下聚多卡醇注射治疗的四肢静脉畸形患儿作为研究对象,比较不同病灶部位和形态的治疗效果,观察记录病变体积变化、症状改善及并发症等情况。结果53例患儿接受治疗时平均年龄为(3.8±3.1)岁。静脉畸形病灶位于上肢31例,下肢22例;局灶性41例,散发性12例。共进行了96人次注射治疗,每个患儿平均接受(1.8±0.9)次注射治疗。治疗完成后,10例疗效为优,29例为良,11例为中,3例为差。从不同病灶部位来看,31例上肢组患儿经治疗后有22例(70.97%)治疗效果为优良,22例下肢组患儿治疗后有17例(77.27%)治疗效果为优良,差异无统计学意义(χ^2=0.263,P=0.608);从病灶形态来看,41例局灶组中治疗效果为优良的34例(82.93%),12例散发组中治疗效果为优良的5例(41.67%),差异有统计学意义(χ^2=6.146,P=0.013)。治疗期间及术后出现心率下降3人次;血压降低2人次,局部疼痛31人次,红肿87人次,发热30人次,暂时性感觉麻木5人次。所有患儿平均随访时间为(9.4±6.5)个月,未见复发病例。结论超声引导下经皮穿刺聚多卡醇注射治疗对于儿童四肢的表浅及中小型静脉畸形,是一种疗效较好、简便易行、经济安全、微创无辐射且并发症少的方法。

Objective To explore the therapeutic efficacies and complications of injecting polidocanol for extremity venous malformations (VM) in children. Methods Fifty-three children with extremity VM received injections of polidocanol under ultrasonic guidance between January 2013 and May 2018.For comparing the therapeutic efficacies of different locations or distributions of VMs,the changes of lesion size,symptoms and complications were recorded. Results The mean age was (3.8±3.1) years.The sites of VM were upper extremity ( n =31) and lower extremity ( n =22).The lesions were focal ( n =41) and diffuse ( n =12).They received a total of 96 treatment sessions.The mean session was 1.8±0.9 per patient.After treatments,the outcomes were excellent ( n =10),good ( n =29),fair ( n =11) and poor ( n =3).And 22(70.97%) upper extremity and 17 (77.27%) lower extremity VM children had excellent/good outcomes.There was no statistical difference (χ^2=0.263,P =0.608);34(82.93%) focal and 5(41.67%) diffuse VM children had excellent/good outcomes.There were statistical differences (χ^2=6.146, P =0.013).During and after treatments,the session number was bradycardia ( n =3),hypotension ( n =2),local pain ( n =31),local swelling ( n =87),fever ( n =30) and transient local numbness ( n =5).During a mean follow-up period of (9.4±6.5) months,there was no recurrence. Conclusion Polidocanol injection under ultrasonic guidance is both safe and effective for superficial,small and medium-sized extremity VMs in children.