婴幼儿血管瘤和血管畸形的临床鉴别诊断

A study on clinical differential diagnosis between hemangioma and vascular malformation in infant

目的研究探讨血管瘤和血管畸形的临床鉴别要点.方法以Mulliken和Waner分类为基础,选择1997年3月至1999年2月在山东省临沂市肿瘤医院初诊,初步诊断为血管瘤未行任何治疗、8个月以内的婴幼儿患者81例.81例中,38例说服家长,随访观察,43例接受糖皮质激素治疗.结果全组病例随访5～7年.38例病变外观呈红色草莓样、仅局限于皮肤的病变,均于2岁以内开始消退.30例病变外观草莓状并伴明显皮下肿物病变,20例表现出不同程度的消退;10例皮下肿物逐渐长大,无消退迹象,其中4例组织活检,3例病理证实为血管瘤伴静脉畸形,1例为血管瘤伴动静脉畸形.13例病变表面皮肤淡蓝色或正常,均伴有皮下肿物者,7例有不同程度的消退;6例持续长大,无消退,其中2例活检,病理证实为静脉畸形.结论婴幼儿血管瘤均在2岁以内开始消退,血管畸形或血管瘤合并深部血管畸形(混合性病变)时,则病变持续长大,无消退.发病时间、病变的生长速度、病变表面皮肤温度、加压后的变化、病变周围皮肤是否有扩张显露的浅静脉、病变区能否扪及动脉搏动以及瘤内造影是否有明显增粗的回流静脉等指标是临床区别血管瘤和血管畸形或混合性病变的重要依据.

Objective To explore the main points of clinical differentiation between hemangioma and vascular malformation in infant. Methods Based on Mulliken and Waner′s classification, from March,1997 to February,1999, 81 baby patients with hemangioma were included in this study. Thirty-eight cases, 43 cases received medical treatment of steroids. Results All the patients were followed up from 5 to 7 years. Thirty-eight cases of red strawberry-like lesions limitied in the skin began to involute within two years old. Of the 30 patients with strawberry-like lesions and subcutaneous mass,20 cases involuted in varying degree; 10 cases′ subcutaneous mass grew gradually and didn′t involute, in 4 cases biopsy was performed, 3 cases were confirmed as hemangioma accompanied with venous malformation by pathology, 1 case was hemangioma accompanied with arteriovenous malformation. Of 13 cases with light blue or normal skin and subcutaneous mass, 7 cases involuted in varying degree; 6 cases grow gradually and didn′t disappear, 2 cases were confirmed as venous malformation by biopsy. Conclusions Hemangioma in infant begins to involute within two years old. Vascular malformation or hemangioma with deep vascular malformation grows persistently and does not disappear. Skin temperature of lesion surface and dilative veins on the skin artery pulsation, are indexes compressibility, for differentiation between hemangioma and vascular malformation in clinical diagnosis.