猪尾引流导管在淋巴管畸形硬化治疗中的应用及疗效分析

目的 探讨猪尾引流导管在大囊型及混合型淋巴管畸形硬化治疗中的应用及疗效.方法 回顾性分析2011年1月至2014年1月确诊并接受猪尾引流导管硬化治疗的26例大囊型及混合型淋巴管畸形患儿临床资料.术前彩色超声、CT或MRI检查结合术中穿刺液检查进一步确诊.全身麻醉后在彩色超声引导下置入猪尾引流导管作引流,每日予平阳霉素溶液作冲洗硬化治疗,拔管前囊腔内保留少量平阳霉素溶液;拔管4周未达到治愈标准者,予平阳霉素局部注射治疗,4周后再评估是否继续注射.结果 26例患儿共置入引流导管26次,冲洗硬化治疗105次.20例患儿经1次置管硬化治疗后达治愈标准,拔管后无需平阳霉素局部注射治疗;2例局部注射1次,2例局部注射2次后达治愈标准;2例局部注射2次后达好转标准.术后随访6～36个月,24例临床症状消除,影像学检查未见瘤体或仅有少量残余硬化病灶,无复发;2例瘤体缩小50％以上,影像学检查仍有少量囊性病灶残余,建议继续随访.本组总治愈率为92.3％,有效率达100％.结论 猪尾引流导管应用于硬化治疗大囊型及混合型淋巴管畸形,具有创伤小、治疗周期短、复发率低及安全有效的特点,值得临床推广应用.     

经皮肝穿刺硬化术与外科切除术治疗巨大肝血管瘤疗效及成本效益对比分析

目的探讨对比分析经皮肝穿刺硬化术与外科切除术治疗巨大肝血管瘤的疗效及成本效益。方法回顾性分析2015年1月～2020年1月我院收治的66例巨大肝血管瘤患者的临床资料。其中男性19例,女性47例,平均年龄(49±9)岁。根据患者所选择手术方式不同,分为穿刺硬化组(29例)及外科切除组(37例)。比较两组患者一般资料、围手术期指标、住院治疗费用、有效率及术后并发症等情况。结果穿刺硬化组的累计手术时间、术中出血量、术中输血量、术后住院天数、住院费用的中位数(30 min、0 ml、0 ml、3天、12092元)均明显小于外科切除组(180 min、300 ml、400 ml、10天、53046元,P 0.01);穿刺硬化组术后1～3天ALT、白蛋白、总胆红素、PT、白细胞、血红蛋白、血小板等指标优于外科切除组(P 0.05)。穿刺硬化组治疗有效率为96.7%,与外科切除组比较差异无统计学意义;穿刺硬化组2例术后发生低热,1例3次术后均出现轻度腹痛,予以对症处理后恢复;外科切除组术后2例发生大量胸腔积液,1例发生肝周大量积液,予以外引流及对症处理后恢复,1例发生肝脓肿,予以穿刺引流及抗感染治疗后恢复。结论经皮肝穿刺硬化术治疗巨大肝血管瘤是一种安全、有效、经济的微创治疗方式,较外科切除术有明显优势。     

DSA引导下经皮硬化术治疗儿童唇部低流速静脉畸形的疗效和安全性分析

目的探讨DSA引导下3%聚多卡醇泡沫硬化剂、平阳霉素联合地塞米松治疗儿童唇部低流速型静脉畸形的疗效和安全性。方法分析我院全麻下行DSA引导下经皮硬化术治疗的27例儿童唇部低回流型静脉畸形患儿的临床资料。共纳入27例患者35个病灶,将观察对象随机分为两组,A组:13例患儿16个病灶,接受3%聚多卡醇泡沫硬化剂治疗;B组:14例患儿19个病灶,接受平阳霉素+地塞米松混合剂注射治疗。观察两组的临床疗效,记录术后不良反应情况,并将其进行对比分析。结果 A组与B组间平均治疗次数、有效率差异无统计学意义(P0.05);两组的不良反应发生率差异有统计学意义(P0.05)。结论 DSA引导下3%聚多卡醇泡沫硬化剂、平阳霉素联合地塞米松治疗儿童唇部低流速型静脉畸形均是有效的方法。平阳霉素联合地塞米松较聚多卡醇泡沫硬化剂更为安全、不良反应少,更值得临床推广。     

介入栓塞联合普萘洛尔治疗婴幼儿弥漫型肝血管瘤7例北大核心CSCD

目的探讨介入栓塞联合普萘洛尔治疗弥漫型婴幼儿肝血管瘤(IHH)的安全性和有效性。方法回顾性分析7例弥漫型IHH患儿临床资料。采用介入栓塞联合口服普萘洛尔治疗方案。微导管超选择瘤体供血动脉,选用平阳霉素碘化油乳剂和聚乙烯醇(PVA)颗粒栓塞病灶,根据有无动静脉分流选择不同注射顺序,40%~50%病灶栓塞后停止栓塞,经肝固有动脉灌注平阳霉素稀释液。随访观察疗效、不良反应及并发症。结果7例弥漫型IHH患儿超选择性肝动脉栓塞术均获成功。术后口服普萘洛尔,逐渐增加剂量至2 mg/kg(2次/d)。术后随访5~14个月,4例完全缓解,2例部分缓解,总有效率为85.7%(6/7),1例死亡。未发生与介入栓塞及普萘洛尔相关并发症。结论介入栓塞联合口服普萘洛尔治疗弥漫型IHH安全有效。弥漫型IHH病情进展较快,建议在出现严重临床症状前尽早治疗。     

口腔颌面部高血流量型血管畸形的经导管栓塞治疗

目的探讨超选择经导管动脉栓塞治疗口腔颌面部高血流量型血管畸形的方法和疗效。方法18例患者中8例行外科术前经导管介入栓塞术,患者均在介入栓塞后72h内行外科切除术;另10例行经导管动脉栓塞根治术,均在全面头颈部血管造影后将微导管超选至供血动脉,注入PVA等栓塞剂栓塞畸形血管团。结果18例患者均超选择插管栓塞治疗成功,技术成功率100%,均未发生皮肤黏膜坏死、颅内动脉误栓塞等严重并发症。术前介入栓塞治疗的8例患者在外科切除术中出血量明显减少,肿块切除变易,手术时间缩短。实施介入栓塞根治术的10例患者,其中1次栓塞治愈者5例,经2次栓塞治愈者4例,3次治愈者1例。经术后1～24个月随访肿块均明显缩小,器官功能改善。结论经导管超选择动脉栓塞治疗口腔颌面部高血流量型血管畸形效果显著,安全、方便。     

难治性颞叶癫痫83例的手术治疗分析

目的:探讨难治性颞叶癫痫(ITLE)的外科治疗方法和效果。方法:83例ITLE患者,术前均行EEG、MRI检查,其中23例行PET,19例行SPECT检查。经测定位后,行手术治疗。其中30例行标准前颞叶切除,37例行标准前颞叶切除 胼胝体切开,16例行病灶切除 致痫灶切除。术中应用皮层电极或深部电极进行检测,并在显微镜下操作。结果:满意47例(56.6%),显著改善23例(26.5%),良好13例(15.6%)。术后无明显并发症,效果良好。结论:手术是ITLE的主要治疗手段,海马硬化和微血管畸形可能是ITLE发生的主要原因。     

儿童静脉畸形介入治疗硬化剂无水乙醇与平阳霉素效果的对比研究

目的 比较无水乙醇碘油混合液与平阳霉素碘油混合液介入硬化治疗儿童静脉畸形的疗效和安全性.方法 2009年2月至2011年5月期间,对80例临床诊断为静脉畸形的患儿进行全麻下介入硬化治疗.80例患儿按照数字表法随机分为A、B组,每组40例.A组行无水乙醇碘油混合液治疗,B组行平阳霉素碘油混合液治疗.术后随访6 ～ 24个月,比较两组疗效及不良反应的发生率.疗效评价分为4级:治愈、基本治愈、有效、无效,治愈、基本治愈、有效的总例数为治疗有效例数.两组患儿的有效率和不良反应发生率采用x2检验比较.结果 A组治疗有效率为95.0％(38/40),B组治疗有效率为65.0％(26/40),差异有统计学意义(x2=11.25,P＜0.01).不良反应:A组8例皮肤破溃、4例瘤体肿胀、2例肌肉纤维化、1例并发脑梗死;B组2例术后出现发热及呕吐,2例皮肤破溃,两者不良反应发生率差异有统计学意义(x2=12.29,P＜0.01).结论 无水乙醇治疗儿童静脉畸形较平阳霉素疗效好,但不良反应发生率较高,其中以皮肤破溃较多见,甚至可造成严重的不良反应如脑梗死.     

无水乙醇联合组织胶硬化栓塞儿童高回流静脉畸形临床疗效分析

目的 探讨无水乙醇联合组织胶硬化栓塞治疗儿童高回流静脉畸形的临床效果.方法 回顾性分析2009年4月至2014年10月全身麻醉下介入硬化剂治疗的339例静脉畸形患儿临床资料.对137例高回流静脉畸形患儿施行无水乙醇联合α-氰基丙烯酸正丁酯(NBCA)硬化栓塞治疗.术后随访6～24个月,平均15个月.结果 137例高回流静脉畸形患儿均成功接受无水乙醇联合NBCA胶治疗,其中23例治愈,31例基本治愈,42例有效(好转),总有效率为70％(96/137).1例NBCA胶回流导致异位栓塞,8例皮肤破溃,3例术中出现一过性肺动脉高压,不良反应发生率为8％(12/137).结论 无水乙醇联合NBCA胶硬化栓塞治疗儿童高回流静脉畸形,是一种安全有效、不良反应发生率低的治疗方法.     

脑岛叶区动静脉畸形的临床特点及显微手术技巧探讨

目的探讨显微手术切除脑岛叶区动静脉畸形的临床特点和显微手术技巧。方法对17例脑岛叶区动静脉畸形患者的临床表现、显微手术技巧、手术结果和术后处理进行回顾分析。结果显微手术切除脑岛叶区血管畸形17例,14例完全切除病灶,3例未完全切除,术后行γ刀辅助治疗。手术效果按GOS评分:恢复良好11例,中度残废4例,严重残废2例,植物生存和死亡均为0例。结论显微镜下外科治疗脑岛叶区动静脉畸形,切除病灶彻底,手术并发症少,疗效满意。     

超声引导乳腺纤维腺瘤微创手术的应用

目的:评价超声引导乳腺纤维腺瘤Mammotome微创切除术的临床应用,并展望其前景。材料和方法:217例328个经术后病理证实为乳腺纤维腺瘤的病灶,在超声引导下进行了微创切除。结果:全部病灶在超声实时监控下进行微创切除,术后超声提示无病灶残留,无一例严重并发症,没有肿瘤残留或复发迹象。结论:超声引导微创手术适用于所有乳腺纤维腺瘤,是乳腺纤维腺瘤患者外科开放式手术理想的替代方法。     

聚多卡醇泡沫硬化治疗儿童Puig's Ⅰ型和Ⅱ型肛周静脉畸形临床研究

目的 探讨DSA引导下聚多卡醇泡沫硬化治疗儿童Puig'Ⅰ型和Ⅱ型肛周静脉畸形的临床疗效.方法 回顾性分析2018年3月至2019年6月就诊于我科的38例Puig'sⅠ型和Ⅱ型肛周静脉畸形患儿,采用全麻下DSA引导经皮多点穿刺3％聚多卡醇泡沫硬化治疗,术后观察疗效、不良反应,术后随访14～28个月.结果 38例患儿共治...     

Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations

Purpose

The purpose of our study was to evaluate the efficacy of percutaneous sclerotherapy using bleomycin in treatment of lymphatic malformations.

Methods

Between January 2009 and January 2013, ten patients with lymphatic malformations who were admitted to the interventional radiology department were included in this retrospective study. Intralesional bleomycin was administered by percutaneous injection through 21–23 Gauge needles with a dose of 1 mg/kg body weight. Patients were clinically and radiologically assessed at baseline and followed at first and third months after treatment. Response to treatment was measured visually by using photographs and by radiological images. Symptomatic improvement was also evaluated either by patients or parents.

Results

Excellent resolution was obtained visually in 80% of patients with lymphatic malformation. Significant resolution was achieved in 20% of patients. The percentage of radiographic resolution in size and the improvement in symptoms evaluated by patients or parents were similar with visual outcomes. No side effects were recorded except for fever in one patient and transient erythema in another patient.

Conclusion

Intralesional bleomycin is a safe and effective treatment for patients with lymphatic malformations.

     

眼眶血管畸形介入硬化栓塞治疗的临床观察

目的探讨介入硬化栓塞治疗眼眶血管畸形的方法,评价其临床疗效及安全性。 方法回顾性分析2013年1月至2019年1月在我院收治的46例眼眶血管畸形患者（包括静脉畸形、动静脉畸形）的临床资料,其中静脉畸形33例,动静脉畸形13例。静脉畸形治疗均为经皮局部硬化治疗（药物为聚多卡醇/无水乙醇）,动静脉畸形以经导管动脉硬化栓塞（栓塞剂为弹簧圈）及经皮局部硬化（药物为聚多卡醇/无水乙醇）联合治疗。随访时间15～57个月（中位随访时间35个月）。 结果33例静脉畸形接受局部硬化治疗次数2～5次（平均3.5次）,13例动静脉畸形接受介入治疗次数2～6次（平均3.9次）。33例静脉畸形至随访期结束时,13例治愈、11例症状明显缓解、9例部分缓解。13例动静脉畸形至随访期结束时,5例自觉血管搏动消失或明显缓解、8例眶周肿胀较前缓解。所有患者均有术后一过性眶周肿胀,未发生眶周皮肤破溃、视力衰退、眼球萎缩及异位栓塞等严重并发症。 结论眼眶血管畸形行介入治疗安全,可以有效地缓解眶周症状。     

Percutaneous ethanol sclerotherapy of venous malformations of the tongue

BACKGROUND AND PURPOSE: Percutaneous ethanol sclerotherapy has been reported to be efficacious for head and neck venous malformations. We sought to evaluate the safety and efficacy of percutaneous sclerotherapy by using ethanol for treatment of symptomatic venous malformations of the tongue. METHODS: Eleven sclerotherapy procedures were performed in seven patients from January 1995 to February 2001. Patient age ranged from 19 months to 57 years (mean age, 32 years). Four patients were male and three were female. Mean follow-up was 36 months. The volume of ethanol used per treatment session ranged from 2 to 32 cc (mean, 16 cc). RESULTS: Sclerotherapy provided significant improvement or resolution of symptoms for all patients. There were no major complications. One patient had a small (3 x 2 cm) area of skin blistering at the injection site. All patients experienced pain and swelling to a variable degree. Sclerotherapy resulted in resolution of symptoms in six of seven patients. Three patients had resolution of symptoms after one procedure. Four patients each underwent two sclerotherapy procedures. One patient who remained symptomatic but improved after undergoing two procedures underwent an anterior glossectomy and is now asymptomatic. CONCLUSION: Percutaneous ethanol sclerotherapy is a safe and effective method of treating symptomatic venous malformations of the tongue.     

儿童肝脏血管瘤的介入治疗方法及疗效的初步探讨

目的探索儿童肝脏血管瘤的介入治疗方法及疗效。 方法回顾性分析我院31例实施肝脏血管瘤介入治疗患者的临床资料。年龄6 d至9岁；先天型肝脏血管瘤26例，婴儿型肝脏血管瘤5例；肝脏多发病变5例，单发病变26例。所有患者均接受CT平扫、CT增强扫描以及肝脏血管瘤硬化栓塞术。依据患者治疗前后CT影像学表现，分析肝脏血管瘤硬化栓塞术对不同分型患者治疗疗效。采用配对样本t检验分别比较婴儿型及先天型肝血管瘤介入治疗术前、术后体积差异。 结果23例接受单次介入治疗，6例接受2次介入治疗，2例接受3次介入治疗。26例患儿接受随访，包括先天型肝血管瘤23例，婴儿型肝血管瘤3例。11例瘤体完全消失，患儿完全康复，15例瘤体部分缩小（4例缩小70%以上，效果显著；6例缩小30%~50%，部分有效；5例缩小低于30%，效果欠佳）。先天型肝血管瘤术前、术后平均体积分别为（161.86 ± 21.40）cm³、（41.46 ± 9.73）cm³，婴儿型肝血管瘤术前、术后平均体积分别为（22.73 ± 1.92）cm³、（11.18 ± 3.18）cm³，术前、术后体积差异均具有统计学意义（P < 0.001）。 结论肝脏血管瘤硬化栓塞术是一种安全、有效的微创治疗方法，对儿童肝脏血管瘤治疗效果较好，且术前分型是儿童肝脏血管瘤介入治疗疗效的重要因素。     

超声介入治疗妇科恶性肿瘤术后盆腔淋巴囊肿

目的:探讨介入超声治疗妇科恶性肿瘤手术后盆腔淋巴囊肿的临床价值。材料和方法:在经腹彩色超声引导下通过穿刺抽液及无水酒精固化对14例卵巢癌、子宫内膜癌、宫颈癌术后症状性盆腔淋巴囊肿共15个囊腔进行超声介入治疗。结果:14例病例15个囊腔均成功地完成了液体抽吸及无水酒精凝固治疗。12例13个囊腔通过一次超声介入治疗囊腔完全闭合。1例多房合并感染者,在抽吸囊液、囊内注入混合性抗生素治疗1周后,行超声介入及无水酒精固化治疗。3个月后复查囊腔完全闭合;另1例治疗后囊腔明显缩小,未经处置,4个月后囊肿自然消失。所有患者介入治疗无直接及晚期并发症发生。结论:超声介入及无水酒精固化治疗妇科恶性肿瘤手术后盆腔淋巴囊肿是一种安全、有效的方法。     

Ethanol sclerotherapy of peripheral venous malformations

BACKGROUND: Venous malformations are congenital lesions that can cause pain, decreased range of movement, compression on adjacent structures, bleeding, consumptive coagulopathy and cosmetic deformity. Sclerotherapy alone or combined with surgical excision is the accepted treatment in symptomatic malformations after failed treatment attempts with tailored compression garments. OBJECTIVES: To report our experience with percutaneous sclerotherapy of peripheral venous malformations with ethanol 96%. PATIENTS AND METHODS: 41 sclerotherapy sessions were performed on 21 patients, aged 4-46 years, 15 females and 6 males. Fourteen patients were treated for painful extremity lesions, while five others with face and neck lesions and two with giant chest malformations had treatment for esthetic reasons. All patients had a pre-procedure magnetic resonance imaging (MRI) study. In all patients, 96% ethanol was used as the sclerosant by direct injection using general anesthesia. A minimum of 1-year clinical follow-up was performed. Follow-up imaging studies were performed if clinically indicated. RESULTS: 17 patients showed complete or partial symptomatic improvement after one to nine therapeutic sessions. Four patients with lower extremity lesions continue to suffer from pain and they are considered as a treatment failure. Complications were encountered in five patients, including acute pulmonary hypertension with cardiovascular collapse, pulmonary embolus, skin ulcers (two) and skin blisters. All patients fully recovered. CONCLUSION: Sclerotherapy with 96% ethanol for venous malformations was found to be effective for symptomatic improvement, but serious complications can occur.     

Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy

Congenital vascular malformations (CVM) are made of dysplastic vessels with no cellular proliferation. Low- or slow-flow malformations (LFM) consist predominantly of venous and/or lymphatic vessels. Correct terminology is necessary for differentiating vascular malformations from tumours such as haemangiomas, in order to prevent ineffective or even adverse therapy. The role of the radiologist in the management of patients is two-fold: making the diagnosis with the use of ultrasound and magnetic resonance imaging, and performing sclerotherapy, which is the treatment of choice. Prior to sclerotherapy, percutaneous phlebography is necessary to visualize the dynamic situation inside the lesion and the flow into the adjacent vascular system. The double-needle technique is a useful therapy option reducing the risk of embolisation of the sclerosing agent. Large lesions might need subsequent surgical treatment. A multidisciplinary approach is substantial for optimal patient management.     

Low-flow vascular malformations: MR-guided percutaneous sclerotherapy in qualitative and quantitative assessment of therapy and outcome

PURPOSE: To prospectively assess the therapeutic procedure and outcome of magnetic resonance (MR)-guided percutaneous sclerotherapy in patients with low-flow vascular malformations. MATERIALS AND METHODS: Seventy-six percutaneous sclerotherapy treatments were performed by one radiologist with real-time MR guidance in 15 patients (six female patients; mean age, 54.4 years +/- 11.1; nine male patients; mean age, 32.9 years +/- 14.1) with vascular malformations in the head and neck (n = 64), spine (n = 5), and extremities (n = 7). Qualitative assessment was used to analyze (a) individual success of therapy, (b) occurrence of complications, (c) time required for minimally invasive MR-guided sclerotherapy in regression analysis, (d) ability of MR imaging to depict postinterventional perfusion changes within the vascular malformation with calculation of changes in contrast-to-noise ratios, and (e) detection of volume changes at follow-up examinations with volumetric analysis. RESULTS: Percutaneous sclerotherapy was performed successfully and without complications by filling targeted vascular malformations with sclerosing agent. Induced vascular sclerosis was used to successfully treat individual predominant symptoms, such as hemorrhage, pain, cosmetic disfigurement, and functional impairment. Quantitative analysis focusing on the actual interventional length of time presented an acceleration over the 5-year time period, matching a cubic function in regression curve fit and taking 31 minutes 50 seconds +/- 14 minutes. Induced vascular thrombosis was identified in all treated portions on postinterventional images by the statistically significant changes in contrast-to-noise ratio (P < .05) compared with preinterventional imaging. On follow-up images (ie, those obtained after 12 weeks +/- 6), shrinkage was observed in targeted portions (67.2% +/- 18.9). CONCLUSION: MR imaging allows safe guidance and monitoring of minimally invasive sclerotherapy and permits verification of therapeutic success postinterventionally and during follow-up examinations.