儿童静脉畸形硬化治疗方法选择与技术

摘要

目的：探讨硬化治疗儿童静脉畸形的临床疗效及相关硬化剂选择原则。方法2008年6月-2013年4月对357例静脉畸形患儿进行全麻下介入硬化治疗。治疗前根据瘤体造影表现和Puig分型，按血流速度及回流静脉类型选择硬化剂。术后随访6～24个月，平均15个月，对患者疗效按治愈、基本治愈、有效、无效进行评估，并统计有效率和不良事件发生率。结果357例患儿成功进行硬化治疗。随访期发现174例治愈，82例基本治愈，80例有效，总有效率为94%。不良反应有短暂的视力障碍6例，皮肤破溃14例，瘤体肿胀39例，肌肉纤维化2例，并发脑梗死1例，肌肉萎缩3例。结论硬化栓塞治疗儿童静脉畸形是一种有效的治疗方法，根据瘤体分型选择合适的硬化剂和治疗终点至关重要。%Objective To explore the clinical effect of sclerotherapy in treating venous malformation in children, and to discuss the selection principles of the relevant sclerosing agents. Methods During the period from June 2008 to April 2013 at authors’ hospital, interventional sclerotherapy under general anesthesia was carried out in 357 children with venous malformation. According to the preoperative angiographic findings (the blood flow velocity and the type of draining vein) and Puig’s classification, the proper sclerosing agent was selected. All the patients were followed up for 6 - 24 months (mean of 15 months). The therapeutic effects were evaluated and were divided as cure, basic cure, effective and invalid. The incidence of side effect was calculated. Results Sclerotherapy was successfully accomplished in all the 357 ill children. During the follow-up period cure was achieved in 174, basic cure in 82 and effective in 80 cases. The total effective rate was 94%. The adverse reactions included transient visual disturbances (n=6), skin ulceration (n=14), tumor swelling (n=39), muscle fibrosis (n=2), cerebral infarction (n=1) and muscle atrophy (n = 3). Conclusion For venous malformations in children, sclerotherapy is an effective treatment. In order to ensure a successful treatment, it is essential to select appropriate sclerosing agent based on the tumor’s classification.(J Intervent Radiol, 2014, 23:292-295).