Sannier K, Dompmartin A, Théron J, Labbé D, Barrellier M T, Leroyer R, Touré P, Leroy D
Services de Dermatologie, Centre Hospitalier Universitaire de Caen, Cedex; France -
Interv Neuroradiol. 2004 Jun 29;10(2):113-27. doi: 10.1177/159101990401000203. Epub 2004 Oct 22.
Absolute ethanol is the most effective agent in the treatment of venous malformation (VM) although it is quite risky to use because of the danger of diffusion beyond the target. To reduce this risk, we have developed an alcoholic sclerosing solution that is less diffusible. The viscosity of absolute ethanol was enhanced with monographic ethyl-cellulose at a concentration of 5.88% ie 0.75 g in 15 ml of absolute ethanol 95%. 23 patients with VM located on the buttock (1), hand (2), leg (1) and face (19) were treated. A mean volume of 1.99 ml of the solution was injected directly into the VM. Each patient had an average of 2.8 procedures. Sixteen patients were done under general anaesthesia and seven with local anaesthesia. Evaluation was performed by the patient, the dermatologist of the treating multidisciplinary team and a dermatological group not involved in the treatment of the patients. Patients were evaluated after a mean delay of 24.52 months. Evaluation of the cosmetic result was made with a five point scale and the global result with a three point scale. VM pain was evaluated by the patients with a Visual Analogue Scale. The aesthetic results were graded as satisfactory (> 3) for the patient and the dermatologist of the multidisciplinary team. However the results were not as good with the independent dermatological group evaluation. The pain was significantly less important after the treatment (p << 0.001). Among the 23 patients, the local adverse events were nine necrosis with or without ethylcellulose fistula followed by only two surgical procedures. There were no systemic adverse events. Sclerotherapy of VM is usually performed with absolute ethanol or ethibloc. The main advantage of our sclerosing mixture is that it expands like a balloon when injected slowly in a aqueous media. Because of the important increase in viscosity the volume of injected solution is much lower than ethanol alone and the risk of systemic reactions is lower. Contrary to ethibloc, post-sclerosing surgery is not necessary because sub-cutaneous ethylcellulose disappears secondarily.
无水乙醇是治疗静脉畸形（VM）最有效的药物，尽管由于其有扩散至靶区以外的风险，使用起来颇具危险性。为降低此风险，我们研发了一种扩散性较小的酒精硬化溶液。通过在无水乙醇中加入浓度为5.88%（即95%的15毫升无水乙醇中加入0.75克）的乙基纤维素来提高无水乙醇的黏度。对23例VM患者进行了治疗，这些患者的VM分别位于臀部（1例）、手部（2例）、腿部（1例）和面部（19例）。平均向VM内直接注射1.99毫升该溶液。每位患者平均接受2.8次治疗。16例患者在全身麻醉下进行治疗，7例采用局部麻醉。由患者、参与治疗的多学科团队中的皮肤科医生以及未参与这些患者治疗的皮肤科小组进行评估。患者在平均24.52个月的延迟后接受评估。使用五点量表对美容效果进行评估，使用三点量表对总体效果进行评估。患者通过视觉模拟量表评估VM疼痛情况。对于患者和多学科团队中的皮肤科医生而言，美容效果被评为满意（>3分）。然而，独立皮肤科小组的评估结果则没那么理想。治疗后疼痛明显减轻（p << 0.001）。在这23例患者中，局部不良事件为9例坏死，伴或不伴有乙基纤维素瘘管形成，随后仅进行了2次外科手术。未发生全身不良事件。VM硬化治疗通常使用无水乙醇或乙碘油。我们的硬化混合物的主要优点是，当缓慢注射到水性介质中时，它会像气球一样膨胀。由于黏度显著增加，注射溶液的体积比单独使用乙醇时要低得多，全身反应的风险也更低。与乙碘油不同，硬化治疗后无需进行手术，因为皮下乙基纤维素会继发消失。
