先天性血管病变的新分类法——178例口腔颌面部血管瘤的重新诊断与评价

CLINICAL APPLICATION OF A NEW CLASSIFICATION OF VASCULAR LESIONS

我们回顾了1990年以来的178例以前被诊断为“血管瘤”的口腔颌面部血管病变,根据病史、体验、照片以及部分病理切片,按Mulliken和Glowacki提出的新的血管病变生物学分类给以重新诊断。结果表明:在这178例中,只有38例(21.35％)为血管瘤,而其它的140例(78.65％)为血管畸形。血管瘤和血管畸形在组织病理,临床表现上完全不同。前者是以血管内皮细胞增殖为特征的,大多数是在患儿出生后1～4月出现,临床表现为迅速的生长及非常缓慢的退化;后者则是先天的血管形态发育障碍,无内皮细胞增殖现象,一般在患儿出生时就存在,并随患儿的生长而逐渐增大,不能退化。所以血管瘤和血管畸形需要分别采用不同的治疗方案。

One hundred and seventy-eight patients with vascular lesions of the oral and maxillofacial region were followed from 1990 to 1991.By history, physical examination, photograph and pathological check, the vascular anomalies which had been termed 'hemangioma' in the past were diagnosed anew, according to new biological classificatioin of vascular lesions proposed by Mulliken and Glowacki.The result suggested that 21% of them were hemangioma and 78% of them were vascular malformation.Hemangioma and malformation were completely different in clincial behavior and endothelial cell characteristics Hemangiomas, those demonstrating endothelial hyperplasia, are often not present at birth, but make their appearance during the first four month.Its clinical behavior is that a pro-liferative phase is followed by a slow involution.Malformations, those with normal endothelial turnover and errors of vascular morphogenesis, are always present at birth.Their growth is commensurate with the patients, and they never regression.Therefor for hemangioma and malformation we should adopt the different therapy plan.