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。

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.