Hassanein Aladdin H, Mulliken John B, Fishman Steven J, Alomari Ahmad I, Zurakowski David, Greene Arin K
Department of Plastic and Oral Surgery, Vascular Anomalies Center, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
Ann Plast Surg. 2012 Feb;68(2):198-201. doi: 10.1097/SAP.0b013e31821453c8.
Venous malformations (VMs) can cause significant morbidity, particularly because they enlarge over time and become symptomatic. The purpose of this study was to determine the natural progression of VMs to facilitate patient counseling, gain insight into pathophysiology, and guide therapy. Our Vascular Anomalies Center database was reviewed for patients with cutaneous and soft-tissue VMs. Predictive variables were age, gender, location, pregnancy, and size. The outcome variable was natural progression of the malformation defined by expansion of the lesion or the onset/worsening of symptoms. The study included 614 patients. Children had a 26.1% risk of progression prior to adolescence, 74.9% before adulthood, and 93.2% over their lifetime. Progression was more likely in adolescence (60.9%) than in childhood (22.5%); the relative risk was 2.6 (95% confidence interval, 2.1-3.2) (P = 0.0001). Diffuse VMs progressed more often than localized lesions (P = 0.002); extremity and trunk VMs worsened more frequently than head/neck lesions (P = 0.03). VMs have a higher risk of progression in adolescents than in children; pubertal hormones may contribute to expansion. Because of their high rate of progression, early treatment of asymptomatic VMs should be considered.
静脉畸形（VMs）可导致严重的发病情况，尤其是因为它们会随着时间推移而增大并出现症状。本研究的目的是确定静脉畸形的自然进展情况，以方便对患者进行咨询、深入了解病理生理学并指导治疗。我们对血管畸形中心数据库中患有皮肤和软组织静脉畸形的患者进行了回顾。预测变量包括年龄、性别、位置、妊娠情况和大小。结局变量是由病变扩大或症状出现/加重所定义的畸形自然进展情况。该研究纳入了614例患者。儿童在青春期前进展的风险为26.1%，成年前为74.9%，终生为93.2%。进展在青春期（60.9%）比在儿童期（22.5%）更常见；相对风险为2.6（95%置信区间，2.1 - 3.2）（P = 0.0001）。弥漫性静脉畸形比局限性病变进展更频繁（P = 0.002）；四肢和躯干的静脉畸形比头颈部病变恶化更频繁（P = 0.03）。静脉畸形在青少年中的进展风险高于儿童；青春期激素可能促使其扩大。由于其高进展率，应考虑对无症状的静脉畸形进行早期治疗。
