增生期血管瘤的个性化治疗

Personalized treatment for proliferating hemangiomas

目的探讨增生期血管瘤的个性化治疗方案。方法选取整形外科2011年1月—2012年6月间50例增生期血管瘤病例,根据增生期血管瘤的部位、大小、色泽、侵及范围、增生速度、功能影响、对患儿及家长心理影响等因素的不同,选择不同的治疗方法。较小的、不位于功能性部位、增生速度缓慢、色泽较暗、消退后无色素沉着及纤维脂肪组织的血管瘤,可等待观察,不采取任何的手段去干预治疗。难治性大、危险性高、面积大、生长迅速、色泽鲜红或位于口唇部位的婴幼儿增生期血管瘤采用口服糖皮质激素治疗。关节、颜面等特殊部位血管瘤,口服激素治疗效果欠佳、较为局限的小范围病变或就诊年龄超过了血管瘤自然消退的年龄采用平阳霉素和(或)曲安奈德注射治疗。非功能性部位或位于头顶部、会阴部血管瘤,或上述几种治疗后仍有较大残存病变者,消退期病灶残存病变、瘢痕、畸形、色素沉着、脂肪堆积等需进一步改善外形和功能采用手术治疗。结果分别采用以上几种方法,治疗效果满意,其中好转20例,治愈30例。结论增生期血管瘤可根据其部位、大小、色泽、侵及范围、增生速度、功能影响、对患儿及家长心理影响及就诊年龄等因素综合考虑,正确选择治疗方法,避免过度治疗或不恰当的治疗方式,准确把握各种治疗方法的疗效、副作用、使用剂量及各种治疗方法的利弊,采用个体化的治疗,是治疗血管瘤的关键所在。

Objective To investigate the personalized treatment for proliferating hemangiomas. Methods 50 patients with proliferating hemangiomas in our department from January 2011 to June 2012 were recruited, and the personalized treatment regime were selected according to the part, size, color, invasion range, hyperplasia speed, functionality, psycho- logical effects on children and their parents. The hemangioma that was smaller, not in the functional parts, hyperplasia slow, clark color or had no pigmentation and fiber adipose tissue were monitored but not intervened. Infantile hemangioma that was refractory, dangerous, large area or grows rapidly received oral corticosteroids. Pingyangmycin or Triamcinolone acetonide injection was conducted on the hemangioma in joints, facial and other special parts, ineffective with oral hormone therapy, limited range of lesions, or the ages of patients over the age of hemangioma spontaneous regression. The surgery was performed for the hemangioma in non-functional parts, the top of the head, perineal, still retaining a large residual le- sions after receiving two treatment methods, subsided phase lesions residual disease, scarring, deformity, pigmentation, or fat accumulation with the need to further improve the appearance and functional. Results The above the personalized treatment gained a favorable curative effect,20 cases were improved,30 cases were cured. Conclusion The appropriate treatments should be chosen according to the site, size, color, invasion area, growth rate, influence on the function, psycho- logical effects on children and their parents, and treatment age and other factors. The overtreatment or inappropriate treat- ment should be avoided. The keys of personalized treatment for proliferating hemangiomas are comprehended correctly the efficacy, side effects, dose ,pros and cons of each regime.