静脉畸形组织结构与治疗选择的临床分析

doi:10.16139/j.1007-9610.2021.06.018

摘要/Abstract

摘要：

目的：根据静脉畸形（venous malformation，VM）组织结构、组织病理特点将病人分成3组，分析治疗方案及对应治疗结果，根据VM组织结构指导治疗方案选择。方法：回顾性分析本院血管瘤科2015年1月至2019年12月170例VM，男73例，女97例，年龄（23.4±9.9）岁。根据标本组织结构将VM分成包膜组141例，非包膜组22例，骨化组7例。超声、磁共振、X线和CT血管造影检查病人。手术或微创治疗VM。术中大体查看和术后VM组织病理检查。术前和出院后行疼痛视觉模拟评分、Oswestry功能障碍指数检测。术后1年随访163例，7例失访。结果：得到3组VM的影像、组织结构与病理表现、治疗方案及疗效评价的数据。包膜组手术101例，治愈78例（77.2%），术后复发2例（2.0%）;微创治疗余40例，包括硬化治疗和射频消融，治愈23例（57.5%），复发2例（5.0%），是预后最佳的组织结构类型。非包膜组手术15例，治愈3例（20.0%），复发4例（26.7%）;微创治疗余7例，治愈1例，复发3例，复发率高（42.9%）。骨化组均手术治疗，7例治愈，无复发。包膜组和非包膜组出院时疼痛视觉模拟评分较治疗前明显降低。所有病例出院时Oswestry功能障碍指数均较治疗前降低。术后6例发生切口延迟愈合等并发症。结论：组织结构可成为VM治疗方案选择及预后判断的有效依据，包膜组疗效最佳，非包膜组疗效差，骨化组只适用手术治疗。

关键词: 静脉畸形, 组织结构, 病理

Abstract: Objective To divide the patients with venous malformation (VM) into three groups based on tissue structure and histopathological characteristics, and analyze results from different treatment scheme in three groups for direction of treatment option according to tissue structure. Methods A retrospective analysis was performed on 170 cases with VM including 73 male and 97 female with mean age of (23.4±9.9) years in Department of Hemangioma this hospital from January 2015 to December 2019. There were 141 cases in enveloped group, 22 cases in non-enveloped group and 7 cases in ossification group with different type of tissue structure of specimens in each group. Patients were examined with image using ultrasonography, magnetic resonance imaging, X-rays and CT angiography. Patients were treated for VM with surgery or minimal invasive techniques. Intraoperative observation and postoperative pathological examination were performed on VM tissue. Visual analogue scale (VAS) and Oswestry disability index (ODI) were detected preoperatively and after discharge. Follow-up was done 163 cases after 1 year discharge and 7 cases lost. Results The data of image, tissue structure, histopathological features, treatment scheme and efficacy evaluation were gotten in three groups. There were 101 cases in enveloped group treated by surgery with 78 (77.2%) cases cured and 2 (2.0%) cases recurred. Remaining 40 cases were treated by minimal invasive operation including sclerotherapy intervention and radiofrequency ablation, in which 23 (57.5%) cases were cured and 2 (5.0%) cases were recurred. The patients in enveloped group had best pattern of tissue structure with best prognosis. Fifteen cases in non-enveloped group were operated with 3 (20.0%) cases cured and 4 (26.7%) cases recurred. Remaining 7 cases were treated by minimal invasive operation with 1 cured case and 3 (42.9%) recurred cases. The recurrence rate was high in non-enveloped group. In ossified group, 7 cases were all treated by surgery and cured without any recurrence. VAS of patients in both enveloped group and non-enveloped group were significantly lower than those before treatment. All patients had lower ODI at discharge than before treatment. There were 6 cases with complication such as delayed incision healing. Conclusions Tissue structure could be an effective index for treatment option and prognosis judgment for VM. The patients in enveloped group would have best results of treatment, while treatment results of patients in non-enveloped group are poor. Ossification of tissue structure is suitable only using surgical treatment.

Key words: Venous malformation, Tissue structure, Pathology

中图分类号:

R543.6

肖莉, 王彦林, 董长宪, 孙斌. 静脉畸形组织结构与治疗选择的临床分析[J]. 外科理论与实践, 2021, 26(06): 550-554.

XIAO Li, WANG Yanlin, DONG Changxian, SUN Bin. Clinical analysis on tissue structure and treatment option of venous malformation[J]. Journal of Surgery Concepts & Practice, 2021, 26(06): 550-554.

图/表 13

表1

表2

图1

图2

图3

图4

图5

图6

图7

图8

图9

表3

表4

参考文献 17

[1]	Wieck MM, Nowicki D, Schall KA, et al. Management of pediatric intramuscular venous malformations[J]. J Pediatr Surg, 2017, 52(4):598-601.
[2]	Carqueja IM, Sousa J, Mansilha A. Vascular malformations: classification, diagnosis and treatment[J]. Int An-giol, 2018, 37(2):127-142.
[3]	Hage AN, Chick JFB, Srinivasa RN, et al. Treatment of venous malformations: the data, where we are, and how it is done[J]. Tech Vasc Interv Radiol, 2018, 21(2):45-54.
[4]	Zhong LP, Ow A, Yang WJ, et al. Surgical management of solitary venous malformation in the midcheek region[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2):160-166.
[5]	Calandriello L, Grimaldi G, Petrone G, et al. Cavernous venous malformation (cavernous hemangioma) of the orbit: current concepts and a review of the literature[J]. Surv Ophthalmol, 2017, 62(4):393-403.
[6]	Jamshidi K, Jafari D, Ramezan Shirazi M, et al. An unusual presentation of ossified intramuscular hemangioma: a case report[J]. Acta Med Iran, 2014, 52(4):319-322.
[7]	Engelstad BL, Gilula LA, Kyriakos M. Ossified skeletal muscle hemangioma: radiologic and pathologic features[J]. Skeletal Radiol, 1980, 5(1):35-40.
[8]	Panda R, Mangal M, Reddy S, et al. Osseous metaplasia mimicking long bone in intramuscular vascualr malformation[J]. World J Plast Surg, 2018, 7(2):243-248.
[9]	Sadick M, Müller-Wille R, Wildgruber M, et al. Vascular anomalies(Part I): classification and diagnostics of vascular anomalies[J]. Rofo, 2018, 190(9):825-835.
[10]	中华医学会整形外科分会血管瘤和脉管畸形学组. 血管瘤和脉管畸形的诊断及治疗指南(2019版)[J]. 组织工程与重建外科杂志, 2019, 15(5):277-317.
[11]	Clemens RK, Baumann F, Husmann M, et al. Percutaneous sclerotherapy for spongiform venous malformations-analysis of patient-evaluated outcome and satisfaction[J]. Vasa, 2017, 46(6):477-483.
[12]	Puig S, Aref H, Chigot V, et a1. Classification of venous malformations in children and implications for sclerothe-rapy[J]. Pediatr Radiol, 2003, 33(2):99-103.
[13]	Han YY, Sun LM, Yuan SM. Localized intravascular coa-gulation in venous malformations: a system review[J]. Phlebology, 2021, 36(1):38-42.
[14]	Dompmartin A, Acher A, Thibon P. Association of loca-lized intravascular coagulophathy with venous malformations[J]. Arch Dermatol, 2008, 144(7):873-877.
[15]	Binet Q, Lambert C, Hermans C. Dabigatran etexilate in the treatment of localized intravascular coagulopathy associated with venous malformations[J]. Thromb Res, 2018, 168:114-120.
[16]	Aronniemi J, Castren E, Lappalainen K, et al. Sclerothe-rapy complications of peripheral venous malformations[J]. Phlebology, 2016, 31(10):712-722.
[17]	Legiehn GM. Sclerotherapy with adjunctive stasis of efflux(STASE) in venous malformations: techniques and strategies[J]. Tech Vasc Interv Radiol, 2019, 22(4):100630.

组别	部位（n）	皮肤脂肪	肌肉	骨骼
包膜组（n=141）	头部（35），四肢（67），躯干（39）	68（48）	61（43）	12（9）
非包膜组（n=22）	头部（4），四肢（15），躯干（3）	5（24）	17（76）	0
骨化组（n=7）	四肢（7）	0	6（86）	1（14）

组别	疼痛	功能障碍	血管内凝血
包膜组（n=141）	118（83.7）	43（30.5）	46（32.6）
非包膜组（n=22）	6（27.3）	1（4.5）	1（4.5）
骨化组（n=7）	3（42.9）	7（100）	0

治疗 170	包膜组 141（82.9）	非包膜组 22（12.9）	骨化组 7（4.1）
手术123（72.4）	101	15	7
治愈	78（77.2）	3（20.0）	5（71.4）
临床治愈	21（20.8）	8（53.3）	2（28.6）
复发	2（2.0）	4（26.7）
微创47（27.6）	40	7	0
治愈	23（57.5）	1（14.2）
临床治愈	15（37.5）	3（42.9）
复发	2（5.0）	3（42.9）

组别	VAS		t值	P值	ODI		t值	P值
组别	术前	出院	t值	P值	术前	出院	t值	P值
包膜组（n=141）	2.38±1.355	0.04±0.221	21.604	<0.01	5.60±6.528	0.04±0.251	10.231	<0.01
非包膜组（n=22）	0.45±0.858	0	2.485	0.02	0.55±0.858	0	2.982	0.01
骨化组（n=7）	0.714±0.951	0	1.987	0.09	17.71±3.817	1.14±1.069	14.388	<0.01