CAJ | 학술논문

目的探讨外科治疗静脉畸形术后残余静脉畸形的介入硬化治疗效果及其安全性.方法在我科接受介入硬化治疗的18例静脉畸形患儿,均曾行外科切除术,术后复查MRI均证实仍有部分残余病灶,其中病灶位于四肢并累及肌层6例,病灶位于膝关节或肘关节腔周围2例,病灶位于颈部且包绕颈部血管或侵入颈动脉鞘3例,病灶位于足底并侵入跖骨间隙2例,病灶位于眼眶2例,累及腮腺1例,累及直肠、乙状结肠2例,上述残余病灶外科往往难于完全切除或家属拒绝再次接受外科手术.上述患儿均在我科接受介入硬化治疗,即在数字减影血管造影仪(Digital Subtraction Angiography,DSA)引导下经皮直接穿刺病灶,并注入聚桂醇泡沫硬化剂或无水乙醇硬化治疗,4周后若患儿未达治愈标准可重复进行,术后随访6个月至2年.结果 18例患儿共接受治疗61次,平均3.4次,术后当天出院率达85.2％ (52/61).治愈3例(16.7％)、好转15例(83.3％)、无效0例,未出现皮肤明显坏死、神经功能损害及心脑肺严重并发症.结论介入硬化治疗外科治疗静脉畸形术后残余静脉畸形具有操作简易、住院时间短、高效且安全等诸多优点,值得在临床广泛推广应用.
목적 탐토외과치료정맥기형술후잔여정맥기형적개입경화치료효과급기안전성.방법 재아과접수개입경화치료적18례정맥기형환인,균증행외과절제술,술후복사MRI균증실잉유부분잔여병조,기중병조위우사지병루급기층6례,병조위우슬관절혹주관절강주위2례,병조위우경부차포요경부혈관혹침입경동맥초3례,병조위우족저병침입척골간극2례,병조위우안광2례,루급시선1례,루급직장、을상결장2례,상술잔여병조외과왕왕난우완전절제혹가속거절재차접수외과수술.상술환인균재아과접수개입경화치료,즉재수자감영혈관조영의(Digital Subtraction Angiography,DSA)인도하경피직접천자병조,병주입취계순포말경화제혹무수을순경화치료,4주후약환인미체치유표준가중복진행,술후수방6개월지2년.결과 18례환인공접수치료61차,평균3.4차,술후당천출원솔체85.2％ (52/61).치유3례(16.7％)、호전15례(83.3％)、무효0례,미출현피부명현배사、신경공능손해급심뇌폐엄중병발증.결론 개입경화치료외과치료정맥기형술후잔여정맥기형구유조작간역、주원시간단、고효차안전등제다우점,치득재림상엄범추엄응용.
Objective To evaluate the efficacy and safety of interventional sclerotherapy for residual venous malformations after surgical resection.Methods 18 patients suffering from residual venous malformation after surgical resection,including 6 cases in the muscle of limbs,2 cases in the elbow or knee region,3 cases in the neck and carotid artery scabbard region,2 cases in the metatarsal region,2 cases in the orbit region,1 case in the parotid gland region and 2 cases in the rectum and sigmoid colon region were reviewed.All patients had pre-procedure magnetic resonance imaging(MRI) study and confirmed residual venous malformation.The reasons for scelrotherapy were difficult redo excision and parental refusal for reoperation.Percutaneous endovascular therapy by direct injection was performed on all 18 cases in our hospital.Sclerosant foam or absolute ethanol was injected into the nidus guided by DSA.Repeat sclerotherapy was again performed if the lesion was not cured in 4 weeks.All cases were followed-up from 6 months to 2 years and the clinical symptoms were observed.Results Sixty one sclerotherapy sessions were perfomed (mean of 3.4 times).According to major symptoms and MRI features,3 cases achieved a complete response and 15 cases achieved partial response.No major complications such as tissue necrosis,peripheral nerve palsy or cardio-pulmonary collapse were found.Conclusions Interventional sclerotherapy for residual venous malformations was found to be easy,safe,and effective.It should be widely used in the treatment of residual venous malformations.