电化学疗法联合泡沫硬化剂治疗静脉畸形的临床效果观察

Observation on the clinical effect of electrochemical therapy combined with foam sclerosing agent on the treatment of venous malformations

目的探讨电化学疗法联合泡沫硬化剂治疗静脉畸形的有效性和安全性。方法回顾性分析2016年1月至2018年12月中日友好医院血管外科使用电化学疗法联合泡沫硬化剂治疗的75例静脉畸形患者资料,术后随访6个月,疗效评价方法参考实体肿瘤疗效评价标准1.1版,根据MRI评估治疗前后病灶大小变化,分析治疗前后的有效率及疾病控制率,并采用χ2检验或Fisher确切概率法比较不同分层因素间的疗效差异。疼痛评分采用视觉模拟评分法,采用配对样本t检验评估治疗前后患者的疼痛症状缓解情况。结果75例患者治疗的有效率为73.3%(55/75),疾病控制率为96.0%(72/75)。分层分析结果显示病灶在多个部位的有效率及疾病控制率均较单个部位降低,差异均有统计学意义(P均<0.05)。病灶直径>20 cm的有效率较直径≤20 cm降低(P<0.001),疾病控制率差异无统计学意义(P=0.241)。既往有电化学治疗史的患者再次采取电化学治疗联合泡沫硬化剂治疗依然有效。术后疼痛评分较术前降低(P<0.001)。并发症均可恢复。结论电化学疗法联合泡沫硬化剂治疗静脉畸形疗效明确,尤其对于广泛性病变效果良好,可重复、多次治疗,且并发症少,疼痛症状改善明显。

Objective To study the efficacy and safety of electrochemical therapy combined with foam sclerosing agent in the treatment of venous malformations.Methods The data of 75 patients with venous malformations treated by electrochemical therapy combined with foam sclerosing agent in the Department of Cardiovascular,China-Japan Friendship Hospital from January 2016 to December 2018 were collected and analyzed retrospectively.The patients were followed up at 6 months after surgery.The solid tumor efficacy evaluation standard(RECIST version 1.1)was applied for efficacy evaluation.MRI were used to evaluate lesion size change and to analyze the response rate and disease control rate before and after treatment.Chi-square test or Fisher exact probability test was used to compare the difference of curative effect among different stratification factors.The pain score was evaluated by visual analog score and paired samples t-test was used to evaluate the improvement of pain symptoms after the therapy.Results The response rate and the disease control rate of the treatment in 75 patients were 73.3%and 96.0%,respectively.The results of stratified analysis showed that the response rate and the disease control rate of malformations in multiple parts were significantly lower than those in single part(both P<0.05).The response rate of malformations whose diameter>20 cm was significantly reduced(P<0.05),while the disease control rate had no significant difference(P>0.05).Electrochemotherapy combined with foam sclerosing agent were still effective to patients who had a previous history of electrochemotherapy.The visual analogue scale(VAS)score was significantly decreased after the surgery(P<0.05).All the complications could be recovered.Conclusion Electrochemical therapy combined with foam sclerosing agent is effective in treating venous malformations,especially for extensive lesions,which can be treated repeatedly,with fewer complications and obvious pain relief.