利用數位影像分析,使用血管硬化劑病灶內注射合併染料雷射複合性治療微血管畸形的回溯性研究

A Retrospective Study of the Efficacy of Different Treatment on Capillary Vascular Malformation: Evaluation of Using Digital Image Analysis

李建智(Jian-Jr Lee)

指導教授 ： 陳明庭 ； 李伯皇

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.01595

摘要

研究背景：
血管紅色母斑（Port-wine stain）是一種微血管的血管畸形，出生時就已經出現、一輩子持續存在，而且會隨著年齡的增長增生肥厚、甚至出現結節性變化。造成患者心理社交上的極大障礙。
臨床上，針對單純的血管紅色母斑一般是使用染料雷射治療，但是由於染料雷射的治療深度不足，治療效果不彰，需要數十次以上的療程，甚至在臨床上有觀察到復發的案例。不但費時、昂貴、更是無效。
而血管硬化劑屬於一種長鏈脂肪酸的鹽類、具有皂類(soap)的性質。主要以陰離子的形式作用在血管內皮細胞。破壞之後，造成血管栓塞，再造成後續的血管的纖維化和阻塞，藉以治療血管異常的疾病，比如說血管瘤、血管畸形、或是靜脈曲張等等。
本研究利用硬化劑在血管紅色母斑做病灶內注射之後，再合併染料雷射治療，預期能得到比原先用單純的染料雷射治療有更好的療效。
而以往對於血管紅色母斑的分類和治療療效的評估，只有主觀的描述，並沒有一個客觀的標準。本研究以數位影像的方法來分析，預期能建立分類和療效的評估標準。

研究目的：
評估以血管硬化劑合併染料雷射治療血管紅色母斑、和傳統治療方法的比較，並藉由數位影像的分析方法，建立客觀的比較基礎。

研究方法：
使用回溯性的方法，把台大醫院及國泰醫院從1986年12月到2006年4月，共267個血管紅色母斑患者列入研究。排除掉合併有其他畸形或合併症、以及追蹤少於六個月的患者，合計有126個個案。
患者分成四個族群，分別是未接受治療組、以染料雷射（Dye laser）治療組、硬化劑治療組、和以血管硬化劑合併染料雷射治療組，進行影像的數位化。另外疾病的進程根據臨床的表現分成幼年期（juvenile stage）、成熟期（肥厚增生期，hypertrophic stage）、及結節病變（nodular change）。而疾病的分類也可分為溫熱型、中間型、和寒冷型。
把患者治療前後的數位化影像標準化之後，以病灶治療前後的直方圖（Histogram）和像素深度加以比對；再利用HSI(色調、飽和度、亮度)模型得到結果，建立一個相對客觀的參數（血管紅色母斑指標），進行分組的統計分析。

結果：
合併治療組治療前後飽和度下降、亮度上升，有統計上的意義；其他組則沒有差異。肥厚增生期的患者、治療前後也沒有差異。但如果以合併治療法治療肥厚增生期的血管紅色母斑，則有明顯差異。
而溫熱型和寒冷型的血管紅色母斑、以任何方法治療，前後皆無顯著差異
另外，女性比男性治療效果良好，分析後可能和女性就醫年齡較低及勤快有關。

關鍵字

血管瘤 ； 血管畸形 ； 血管紅色母斑 ； 硬化劑 ； 染料雷射 ； 數位影像 ； 色彩模型

並列摘要

Background:
Port-wine stains (PWS) are capillary forms of vascular malformation. They are usually found at birth, persist throughout the whole life, and progress to hypertrophic stage, and sometimes complicate with nodular change. The patients with port-wine stains may usually suffer from psychological disabilities and social withdraw.
Clinically, the physicians used to treat simple PWS with dye laser, but they can not get a long term good result for mature PWS because of limited penetration of laser. It may take dozen times to treat PWS, and may fail eventually.
Sodium tetradecyl sulfate (STS) is a kind of sclerosing agent, which belongs to a salt of long chain fatty acid, like soap, and works on the endothelial cells of vessels and damages the intima, and then leads to vascular thrombosis and subsequent fibrosis. The physicians use it for treating vascular lesions, such as vascular malformation and varicose vein.
In this study, we treat the PWS lesions with sclerosing agent injection first for several times, and then combine with dye laser treatment to get better results.
We utilize the technique of digital image processing to establish the objective assessments for clinical results, and discuss with statistical methods.
Materials and methods:
267 patients are collected from two medical centers (National Taiwan University Hospital and Cathay General Hospital) at Taipei, from December 1986 to April 2006. All data are analyzed retrospectively. 126 cases remain in the study after we exclude the cases that their following time are less than 6 months and those combined with other vascular deformities.
They are assigned into four treatment groups: non-treatment, laser treatment only, sclerotherapy only, and combination of laser and sclerosing agent treatment group. These patients are also grouped by disease progression, as juvenile stage, hypertrophic stage, and nodular change. The pathophysiologic status of the PWS is also taken into consideration, and is divided as warm type, intermediate type, and cold type.
After treatment, pre and post therapy images are assessed with computer software under the HSI (hue, saturation, intensity) color image model. The differential ratio of the lesion to the normal skin by the change of saturation and intensity during treatment is defined as PWS index, which is comparable on the same patient, and then discussed with statistical methods.
Results:
There are significant changes after combination treatment, but not so by other treatment. The juvenile stage patients have the better results than hypertrophic stage patients in all treatment groups. But if we treat the hypertrophic stage PWS patients with combination method, they could still get a significant improvement after treatment.
The intermediate type PWS patients have the better results than warm and cold type patients. It means the warm and cold type PWS may have relatively poor outcome.

並列關鍵字

Port wine stains ； vascular malformations ； sclerotherapy ； sclerosing agent ； dye laser ； digital image processing ； color model

參考文獻

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