Polidocanol Microfoam 有益于天生静脉畸形的病患


  Nov. 17, 2003--一项发表于十一月Archives of Dermatology的最新研究显示,polidocanol microfoam的硬化剂注射疗法对天生性静脉畸形的病患有效。
  
  西班牙Pamplom a那瓦尔大学诊所Juan Cabrera博士和同事表示,普通大小的静脉畸形必须接受外科手术的治疗,但是对于更大范围的畸形,施行外科手术则会引起运动功能的丧失、神经损害,和严重出血。然而,硬化剂注射疗法能用于缩小手术前或受术之后的损伤尺寸。
  
  在他们的报告中,研究人员发表以microfoam治疗静脉畸形病患的首次描述,他们宣称「这项新颖的方法扩大硬化剂注射疗法效果及克服液态硬化剂的限制。」
  
  根据研究人员指出,由于血管逐渐的稀释和不规则的使得液态硬化剂的剂量难以控制,microfoam硬化剂由CO2微泡所组成,与液态硬化剂相比会增加表面积,它也允许硬化剂与血管壁内皮均质接触,因为polidocanol会出血。
  
  研究人员引导了一项50位病患的医学记录、治疗前后彩色显影、超音波结果、及磁共振摄影(MRI)的回溯性研究,其中19位有局限性静脉畸形、16位有渗透性静脉畸形、和15位Klippel Trenaunay症候群。
  
  经皮注射的硬化剂疗法是经超音波引导以0.25%到4% polidocanol microfoam直接注射,期间的次数范围由1到46次,平均每位病患接受12期的注射。
  
  Cabrera医师及同事发现50位病患中有92%对治疗有反应,在有反应的病患之中,有18位的畸形消失,15位病患中有超过一半的畸形尺寸缩小,剩余的13位病患畸形尺寸缩小的人数少于二分之一,在39位疼痛的病患中,有14位的疼痛减轻,而其它25位的痛苦则完全消除。
  
  研究人员的报告表示,没有任何病患发生严重的不良反应,尽管有四位病患产生短暂的皮肤色素沉著和三位产生皮肤坏死。
  
  Cabrera医师和同事作出结论,这项技术仅用于非卧床病患及被证实是简单且无害的,它的质量及持久性使得这项新颖的方法成为照顾先天性静脉畸形病患的选择疗法。
  
  在一项相关的社论中,Chestnut Hill 的皮肤照护医师Te-Shao Hsu博士表示,对于静脉畸形并没有明确的标准治疗方法,但是foam是一项新的手术技术,只要正确地使用将具有极大的功效与用途。
  
  他指出,foam硬化剂注射疗法也可以用于改善严重慢性静脉功能不全、静脉溃烂、lipodermatosclerosis、及男性精索静脉曲张和骨盆腔郁血。

Polidocanol Microfoam Benefits

By Emma Hitt, PhD
Medscape Medical News

Nov. 17, 2003 — Sclerotherapy with polidocanol microfoam appears to be effective in most patients with congenital venous malformations, new research in the November issue of the Archives of Dermatology suggests.

A surgical approach is indicated for venous malformations of moderate size, but for more extensive malformations, surgery can lead to loss of motor function, nerve damage, and massive bleeding, note Juan Cabrera, MD, from the University Clinic of Navarra, Pamploma, Spain, and colleagues. However, sclerotherapy may be used to reduce the size of lesions before or after surgery.

In their report, the researchers present the first description of administering microfoam to patients with venous malformations. "This novel approach may widen the indications of sclerotherapy and overcome the limitations of sclerosants in liquid form," they assert.

According to the researchers, the dosage of sclerosing liquids is difficult to control because of the progressive dilution and irregular distribution of the vessels. Sclerosant microfoam consists of CO2 microbubbles, which creates an increased surface area compared with liquids. It also permits homogeneous contact between the sclerosant and the endothelium, because polidocanol displaces the blood.

The researchers conducted a retrospective study of medical records, color photographs before and after treatment, sonogram results, and/or magnetic resonance imaging (MRI) in 50 patients. Of the patients, 19 had limited venous malformations, 16 had infiltrating venous malformations, and 15 had Klippel Trenaunay syndrome.

Percutaneous sclerotherapy was performed by direct injection of 0.25% to 4% polidocanol microfoam under ultrasound guidance. The number of sessions ranged from 1 to 46, with an average of 12 sessions per patient.

Dr. Cabrera and colleagues found that 92% of the 50 patients responded to treatment. Among the responders, malformations disappeared in 18 of the patients, malformation size decreased by more than half in 15 patients, and by less than half in 13 patients.

Of the 39 patients who presented with pain, 14 experienced reduced pain, and pain was entirely eliminated in the other 25 patients.

"No major adverse events were reported by any patient," the researchers report, although four cases of transient skin pigmentation and three cases of skin necrosis occurred.

"The technique is delivered on a strictly ambulatory basis and has proved simple and innocuous," Dr. Cabrera and colleagues conclude. "The quality and durability of the outcome make this novel procedure the treatment of choice in the care of patients with congenital venous malformations," they add.

In a related editorial, Te-Shao Hsu, MD, from SkinCare Physicians of Chestnut Hill, notes that there are "no defined standards for the treatment of venous diseases, but foam is a new surgical technique with promise of great efficacy and versatility when used properly."

He points out that foam sclerotherapy also has been used to improve severe chronic venous insufficiency, venous ulcerations, lipodermatosclerosis, and male varicocele and pelvic congestion.

Arch Dermatol. 2003;139:1409-1416

Reviewed by Gary D. Vogin, MD

    
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