Pathogenesis And Safety Research Of Neuropathy After Sclerotherapy Of Venous Malformations

BackgroundVenous malformation(VM)is a common congenital low-flow vascular anomalies.It process with age and may has serious effects on the function and appearance of patients.Many methods have been used in the treatment of VM,while the sclerotherapy is the most important one.Sclerotherapy show a excellent treatment result of VM and at the same time with some boring complications,which caused by various sclerosants.Nerve injury is one of the most serious complications of sclerotherapy.Now we do not have a clear sense of the pathogenesis of nerve injuries and a right evaluation to different sclerosants.Therefore,we chose ethanol and 1%lauromacrogol as the objects of research to study the structure and function effects of nerve fibers.Then,test and compare the result with clinical study.Have a correct understanding of these information is helpful in selecting proper sclerosant and avoiding nerve injuries.Material and Methods1.(1)Observe the motor function changes of rat’s foot and legs,nerve conduction and pathohistology structure changes of nerve in different time points(1 day,2 weeks,4weeks,8 weeks)after different dose(0.1 ml,0.2 ml)ethanol was dropped on the nerves.(2)Observe the motor function changes of rat’s foot and legs,nerve conduction and pathohistology structure changes of nerve in different time points(1day,2 weeks,4 weeks,8 weeks)after different dose(0.1 ml,0.2 ml)1%lauromacrogol was dropped on the nerves.(3)Compare the different changes of he nerve’s structure and function after the two sclerosants injected.2.Respective analysis of nerve injury after sclerotherapy of VM from January 2014 to March 2015 in our institution.Study the occurrence,development and prognosis of the nerve injuries after the patient accepted ethanol sclerotherapy.Study the occurrence,development and prognosis of the nerve injuries after the patient accepted lauromacrogol sclerotherapy.Compare the different clinical features after the two sclerosants injection.ResultPart 1: After the ethanol was dropped on the nerves,at different record time point(1 d,2 week,4 week,8 week),evaluation of lower limbs motor-function: 0.1ml group show 0.85±0.37,1.27±0.46,3.70±0.67 and 3.79±0.45;0.2ml group show0.70±0.47,0.87±0.35,1.40±0.52 and 2.80±0.84;C group are3,4,4 and 4;D group are2.95±0.22,4,4 and 4;NS group are 3,4,4 and 4;control group are all 4。Function of nerve conduction:at two weeks,the Lat value in both 0.1ml group and0.2ml group are12.16±1.82 and 13.83±1.36,longer than the value in control group and NS group,whose value are 6.32±0.95 and 6.11±0.97(P<.05).The value of Amp are 10.83±2.00 and 9.86±3.17,lower than control group and NS group,whose value are 6.11±1.96 and 5.63±2.04.The Lat value of group C and group D are 7.47±4.05 and 6.65±1.05,longer than the control group(P<0.05),but no difference with group NS(P>0.05)。At fourth and eighth week,all the four group have improvement of their Lat and Amp,but still in a abnormal value region.Historical structure: In the 0.1ml ethanol group,mild destruction is 15% percent;middle destruction is 60%,heavy destruction is 25%.In the 0.2ml ethanol group,mild destruction is 5% percent;middle destruction is 50%,heavy destruction is 45%.In 0.1ml lauromacrogol group,normal examples is 20%,mild destruction is 80% percent.In 0.2ml lauromacrogol group,normal examples is15%,mild destruction is 85% percent.In NS group,normal examples is 80%,mild destruction is 20% percent.In the control group,all examples are normal historical structure.Ultrastructure change: In the 0.1ml ethanol group,mild destruction is 7.5%;middle destruction is 57.5%,heavy destruction is 35%.In the 0.2ml ethanol group,middle destruction is 55%,heavy destruction is 45%.In 0.1ml lauromacrogol group,normal examples is 10%,mild destruction is 90% percent.In 0.2ml lauromacrogol group,normal examples is 5%,mild destruction is 95% percent.In NS group,normal examples is 77.5%,mild destruction is 22.5% percent.In the control group,all examples are normal historical structure.Part2: 337 patients accept ethaol scoltherapy and 146 patients acccept lauromacrogol sclerotherapy.Ethanol shows a better effectiveness than 1%lauromacrogol(P<0.05),the technical success rate are not different between ethanol and lauromacrogolis.Totally 12 patients appeared 13 times nerve injury related symptoms,11 patient accept ethanol sclerotherapy and 1 patient accept lauromacrogol sclerotherapy.All of these symptoms occurred in the region distributed with important nerve branch.After 3 to 15 months follow-up,9 patients partially or completely recovered after their nerve were injured by ethanol.2 patients without evidently improvement during the follow up.The symptom of nerve injury disappeared with the swelling decrease of the patient who had accept lauromacrogol sclerotherapy.ConclusionBoth ethanol and lauromacrogol can damage the historical structure and the function of nerve conduction,but the ethanol can lead to more serious structural destruction than lauromacrogol.The effects caused by ethanol have a relation with the does of sclerosant and can affect the motor function of lower limbs,while the lauromacrogol do not.Both ethanol and lauromacrogol show good effectiveness of sclerotherapy,but ethanol is better.At the same time,lauromacrogol shows better nerve safety than ethanol.