Ozaki Mine, Kurita Masakazu, Kaji Nobuyuki, Fujino Takashi, Narushima Mitsunaga, Takushima Akihiko, Harii Kiyonori
Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, Japan.
Scand J Plast Reconstr Surg Hand Surg. 2010 Apr;44(2):75-87. doi: 10.3109/02844310903569725.
Excision of intramuscular venous malformations may damage intact functional muscles, and sclerotherapy is an alternative way of relieving symptoms. Several sclerosants are available, but selection of the optimal one is controversial. We report our clinical experiences of sclerotherapy, and experimental studies in rats that investigated muscular damage after injection of various sclerosants. For the clinical study, 10 patients with intramuscular venous malformations were reviewed who had been treated by sclerotherapy using ethanolamine oleate. The rate by which the volume reduced was assessed quantitatively using findings from magnetic resonance imaging (MRI). Pain was cured or improved in all cases, and volume reduced on imaging analysis. There were no severe complications such as renal failure or thromboembolism. For the experimental study, 62 Wistar rats were used to investigate the toxicity of sclerosants on the intact-muscle by injecting three types of sclerosants (100% ethanol, 5% ethanolamine oleate, and 1% polidocanol). After the injection of each sclerosant into the anterior tibial muscle, the daily measurement of the circumference of the legs, histological and morphological alterations in the muscles, and maximal isometric tetanic tension, were investigated. Swelling was most prominent with ethanolamine oleate, while destruction and atrophy of the muscle were most prominent after injection of ethanol. In the clinical study, the efficacy of 5% ethanolamine oleate was at least equivalent or possibly superior to that of 100% ethanol. In the experimental study, ethanol had a more detrimental effect on muscles than the other agents. We consider that ethanolamine oleate is the most suitable sclerosant for the treatment of intramuscular venous malformations.
肌内静脉畸形切除术可能会损伤完整的功能肌肉，而硬化疗法是缓解症状的另一种方法。有几种硬化剂可供选择，但选择最佳的硬化剂存在争议。我们报告了硬化疗法的临床经验，以及在大鼠身上进行的实验研究，该研究调查了注射各种硬化剂后的肌肉损伤情况。对于临床研究，回顾了10例接受油酸乙醇胺硬化疗法治疗的肌内静脉畸形患者。使用磁共振成像（MRI）结果定量评估体积缩小率。所有病例的疼痛均得到治愈或改善，影像学分析显示体积缩小。没有出现肾衰竭或血栓栓塞等严重并发症。对于实验研究，使用62只Wistar大鼠通过注射三种类型的硬化剂（100%乙醇、5%油酸乙醇胺和1%聚多卡醇）来研究硬化剂对完整肌肉的毒性。在将每种硬化剂注射到胫前肌后，研究腿部周长的每日测量、肌肉的组织学和形态学改变以及最大等长强直张力。注射油酸乙醇胺后肿胀最为明显，而注射乙醇后肌肉的破坏和萎缩最为明显。在临床研究中，5%油酸乙醇胺的疗效至少与100%乙醇相当，甚至可能更好。在实验研究中，乙醇对肌肉的损害比其他药物更大。我们认为油酸乙醇胺是治疗肌内静脉畸形最合适的硬化剂。
