335例先天性血管畸形诊断治疗体会

The Diagnosis and Treatment of Congenital Vascular Malformation: Report of 335 Cases

目的：探讨先天性血管畸形（血管瘤）诊断与治疗的方法。方法：分析３３５例血管瘤的临床表现、体格检查、辅助检查和造影、ＣＴ、ＭＲＩ等及治疗方法如手术、手术结合钢针、铜针、硬化剂、术中缝扎和电凝的应用。结果：本组手术切除１６１例，部分切除８１例，硬化剂注射３２例，铜针治疗１８例，需植皮４７例，皮瓣修复１９例，１期治疗２８４例，分期治疗３５例。达到“治愈”或“缓解”的３１０例。效果差者多为蔓状血管瘤，最终截肢５例，仍有缺血溃疡者５例。３６例出现切口或植皮愈合不佳的并发症。结论：（１）除作出毛细血管瘤、海绵状、蔓状血管瘤等“定性”诊断外应作出血管瘤大致范围、深度、累及重要组织的“定位”诊断或“解剖”诊断，以便指导治疗。（２）血管瘤应及时治疗。方法以手术为主，结合或单用硬化、铜针等或术中加用缝扎、电凝破坏、硬化剂以处理残留病变。

Objective: To study the diagnosis and treatment of the congenital vascular malformation (haemoangioma). Methods: Analyzing the application of clinical manifestation, physical examination, angiography, CT and MRI in diagnosis and the application of operation, operation with copper needle therapy, copper needle therapy, injection therapy and suturing and/or coagulation during surgery in 335 cases of hemangioma. Results: The techniques included the excision(161 cases), partial excision(81 cases), injection therapy(32 cases), copper needle therapy(18 cases), split - thickness skin graft(47 cases), skin flap(19 cases). 284 patients got one course of treatment. 35 patients got multiple courses. 310 patients were cure and relief. There were 5 amputation and 5 ulceration in 51 congenital aterio - vasclar malformation. The heal of wound and the taken of the skin graft delayed in 36 cases. Conclusion: 1. The 'location' or 'anatomy' diagnosis about the range,the depth and the involvement of important tissue of the lesion should be made to supply a few points for treatment in addition to the traditional diagnosis of capillary, cavernous or racemose hemangioma. 2. Hemangioma sould be treated promptly. Operation is the main method for treatment of hemangioma. The other techniques include injection therapy, cooper needle therapy, suturing and coagulation.