Huang Shuting, Xu Fenglin, Li Xin, Zhang Hongxia, Chen Jingyu, Zhao Zhenzhen, Zhang Jun, Peng Liang, Kong Xiangru
Department of Oncological Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
J Vasc Surg Venous Lymphat Disord. 2025 Mar 25;13(4):102240. doi: 10.1016/j.jvsv.2025.102240.
The aim of this study was to report our center's experience in treating pediatric vascular malformations using ultrasound-guided microwave ablation.
Twenty-two symptomatic children with vascular malformations underwent ultrasound-guided microwave ablation. All patients received ultrasound follow-up after microwave ablation, whereas magnetic resonance imaging follow-up was conducted depending on the disease's condition. The Visual Analog Scale and the PedsQL4.0 Chinese Version was utilized to assess the changes in pain severity, limb motion evaluation, and quality of life before and after treatment.
The study included 22 cases, comprising four arteriovenous malformations, nine venous malformations, two diffuse microcystic lymphatic malformations, two cases of Klippel-Trenaunay syndrome, and five cases of fibro adipose vascular anomaly. All children presented with pain at the affected site (22 cases; 100%). The malformations were located in the limbs in 17 cases (77%), subcutaneous and intramuscular tissues of the buttocks in one case (4.5%), subcutaneous tissue of the abdominal wall in one case (4.5%), and retroperitoneal in three cases (14%). All 22 patients (100%) experienced pain. Additionally, 20 cases (91%) exhibited swelling at the affected site or developed swelling after physical activity. Limb hypertrophy was observed in five cases (23%), whereas another five cases (23%) showed signs of limb atrophy. Joint mobility restrictions were present in four cases (18%). Among these 22 patients, 17 cases (77.3%) experienced complete resolution of pain and local lesion appearance changes, whereas four cases (18.2%) reported pain relief. However, in one case (4.5%) of Klippel-Trenaunay syndrome, postoperative improvement was observed at the treatment site, but a new centripetal malformation developed within the treated region. This patient subsequently underwent surgical intervention, resulting in an improvement in clinical symptoms. The pre-treatment malformation volume was 209.85 ± 343.17 cm, which reduced to 32.95 ± 66.04 cm 1 year after ablation. The volume reduction was statistically significant (t = 2.374; P = .026; P < .05), with an average volume reduction rate of 85.51%. No major complications were found, such as nerve damage or skin burns.
Ultrasound-guided microwave ablation is a relatively safe and effective technique for treating pediatric vascular malformations. Further multicenter studies are recommended to validate these findings.
本研究旨在报告我们中心使用超声引导下微波消融治疗小儿血管畸形的经验。
22例有症状的小儿血管畸形患者接受了超声引导下微波消融治疗。所有患者在微波消融后均接受超声随访，而磁共振成像随访则根据病情进行。采用视觉模拟评分法和儿童生活质量量表4.0中文版评估治疗前后疼痛严重程度、肢体运动评估和生活质量的变化。
该研究纳入22例患者，包括4例动静脉畸形、9例静脉畸形、2例弥漫性微囊性淋巴管畸形、2例Klippel-Trenaunay综合征和5例纤维脂肪血管异常。所有患儿均有患部疼痛（22例；100%）。畸形位于四肢17例（77%），臀部皮下及肌肉组织1例（4.5%），腹壁皮下组织1例（4.5%），腹膜后3例（14%）。22例患者均有疼痛（100%）。此外，20例（91%）在患部出现肿胀或在体力活动后出现肿胀。5例（23%）观察到肢体肥大，另5例（23%）出现肢体萎缩迹象。4例（18%）存在关节活动受限。这22例患者中，17例（77.3%）疼痛完全缓解，局部病变外观改变，4例（18.2%）疼痛减轻。然而，1例Klippel-Trenaunay综合征患者（4.5%）治疗部位术后有改善，但在治疗区域内出现了新的向心性畸形。该患者随后接受了手术干预，临床症状得到改善。消融前畸形体积为209.85±343.17cm，消融1年后减小至32.95±66.04cm。体积减小具有统计学意义（t=2.374；P=0.026；P<0.05），平均体积减小率为85.51%。未发现严重并发症，如神经损伤或皮肤烧伤。
超声引导下微波消融是治疗小儿血管畸形的一种相对安全有效的技术。建议进一步开展多中心研究以验证这些结果。
