尿素与甲基强的松龙联合介入治疗颌面部重症血管瘤伴血小板减少

Interventional therapy with urea and methylprednisolone in management of severe maxillofacial hemangioma with thrombocytopenia

目的探讨婴幼儿颌面部重症血管瘤伴血小板减少的治疗方法。方法收集分析2001至2006年我科收治的35例颌面部重症血管瘤伴血小板减少患儿的临床表现及治疗经过，年龄最小10d，最大5个月，平均31d，血小板明显减低，在76×10^9／L以下，最低至6．2×10^9／L，采用颈外动脉结扎置管、40％尿素溶液与甲基强的松龙针剂联合介入治疗的方法。平均随访1年8个月。结果35例患儿中，血小板计数3～7d恢复到正常的30例，8～11d5例；血管瘤瘤体逐渐缩小，6～12个月消失28例，13～23个月7例。其中3例出现病情反复。结论颈外动脉结扎置管、尿素与甲基强的松龙联合介入治疗婴幼儿颌面部重症血管瘤伴血小板减少，疗效确切，创伤小，副作用少。本疗法操作简便，不需要特殊设备，易于推广，是一种较为理想的治疗小儿颌面部重症血管瘤伴血小板减少的方法。

Objective To evaluate the treatment of severe infantile maxillofaeial hemangioma associated with thrombocytopenia. Methods Thirty five cases of severe maxillofacial hemangioma with thrombocytopenia managed in our hospital between 2001 and 2006 were reviewed. The mean age was thirty one days, ranging from ten days to five months. The platelet count in these cases was below 76 ×10^9/L. The lowest platelete count was 6. 2 ×10^9/L. All the patients were treated with ligation of external carotid artery,insertion of a tube inside the lesion and injection of 40% urea and methylprednisolone. The average follow up period was one year and eight months. Results Among the 35 cases, the thrombocyte count in 30 cases returned to normal within 3-7 days. In the remaining 5 cases, it normalized within 8-11 days. The size of the hemangiomas decreased gradually after the therapy. The hemangiomas in 28 cases disappeared completely in 6 12 months and 7 cases disappeared in 13-23 months. In the course of the therapy, three cases were recurrent in these cases. Conclusions The urea combined with methylprednisolone interventional therapy is a reliable method with minimal side-effect and trauma. It requires no special instruments and is easy to popularize. It is a better method for the severe he mangioma of children in maxillofacial region.