Songsaeng Dittapong, Churojana Anchalee, Khumthong Rujimas, Mahiwan Laksanawadee
J Med Assoc Thai. 2015 Apr;98(4):408-13.
To assess and compare the effectiveness of the two sclerosing agents (95% alcohol and Bleomycin) for the treatment of head and neck venous malformation (VM).
The authors retrospectively reviewed our experience in treating VM of the head and neck region using two sclerosing agents, 95% alcohol (November 2001 to June 2008) and bleomycin (July 2008 to July 2010). Patients' demography (age, sex), lesion number location, type (focal/extensive), and characteristic features (cystic/tubular/mixed) were recorded. The treatment outcome was determined by decrease in size of VM in photographs taken at one month and at final clinical follow-up. These were analyzed by two radiologists using visual rating scale (worst or not improved, <50%, 50-75%, >75% of size reduction). One-way Anova test (p < 0.1) was used to show the differences in treatment effectiveness of the two sclerosing agents at short- and long-term intervals.
Thirty-three patients, age ranged from 11 to 62 years (mean 25.1 years), with 27 female and six male patients were included in this study. The majority of patients were less than 16 years (17 patients, 51%). The 43 lesions were categorized as 28 VMs were focal (65.1%), 15 (34.9%) diffuse, and30 (69.7%) were of the mixed type. Sixteen lesions were treated with 95% alcohol, 23 lesions with bleomycin, and four lesions with a combination of the two sclerosants. The range of number of procedures was 1 to 16 (mean 3.76 procedures per patient) for alcohol, and 1 to 5 (mean 2.27 procedures per patient) for bleomycin. The cumulative dose ofsclerosant used was 101 ml for alcohol and 32.11 mg for bleomycin. Total follow-up at 1-month and at final was 43/43.(100%) and 35/43 (81.4%) respectively. Mean follow-up interval was 14.7 months. Differences in size reduction after treatment by different sclerosing agents were found. At more than 1-year follow-up, those treated with bleomycin gained graded 3 (> 75%) size reduction more than treated by 95% alcohol. No VM treated with 95% alcohol obtained grade 3 of size reduction at 1-year follow-up. Multiple regression analysis showed VM's favorable character for bleomycin treatment by decreasing mixed, cystic, and tubular Pediatrics had relatively more benefit with bleomycin treatment.
Sclerotherapy using either alcohol or bleomycin is an effective treatment for VMs. Different treatment outcomes were significant at long-term with group of VM those treated with bleomycin but not at short-term (p < 0.1).
评估和比较两种硬化剂（95%乙醇和博来霉素）治疗头颈部静脉畸形（VM）的有效性。
作者回顾性分析了使用两种硬化剂（2001年11月至2008年6月使用95%乙醇，2008年7月至2010年7月使用博来霉素）治疗头颈部VM的经验。记录患者的人口统计学资料（年龄、性别）、病变数量、位置、类型（局限性/广泛性）以及特征（囊性/管状/混合型）。通过比较治疗后1个月及最终临床随访时拍摄的照片中VM大小的减小情况来确定治疗效果。两名放射科医生使用视觉评分量表（最差或无改善、缩小<50%、缩小50 - 75%、缩小>75%）进行分析。采用单因素方差分析（p < 0.1）来显示两种硬化剂在短期和长期治疗效果上的差异。
本研究纳入了33例患者，年龄在11至62岁之间（平均25.1岁），其中女性27例，男性6例。大多数患者年龄小于16岁（17例，51%）。43处病变中，28处（65.1%）为局限性VM，15处（34.9%）为弥漫性VM，30处（69.7%）为混合型。16处病变采用95%乙醇治疗，23处病变采用博来霉素治疗，4处病变采用两种硬化剂联合治疗。乙醇治疗的操作次数范围为1至16次（平均每位患者3.76次），博来霉素治疗的操作次数范围为1至5次（平均每位患者2.27次）。乙醇使用的硬化剂累积剂量为101 ml，博来霉素为32.11 mg。1个月及最终随访的总例数分别为43/43（100%）和35/43（81.4%）。平均随访时间为14.7个月。发现不同硬化剂治疗后大小缩小存在差异。在1年以上随访时，接受博来霉素治疗的患者达到3级（> 75%）大小缩小的比例高于接受95%乙醇治疗的患者。在1年随访时，接受95%乙醇治疗的VM无达到3级大小缩小的情况。多元回归分析显示，混合型、囊性和管状特征的VM对博来霉素治疗反应良好，儿童患者接受博来霉素治疗相对更有益。
使用乙醇或博来霉素进行硬化治疗是VM的有效治疗方法。长期来看，博来霉素治疗组的VM治疗效果差异显著，但短期无差异（p < 0.1）。
