血管瘤和血管畸形美容治疗的探讨

目的 探讨血管瘤的有效治疗方法以及各种治疗方法对美容的影响。方法 对260例口腔颌面部血管瘤的诊治进行回顾性分析，治疗中着重以美容治疗模式为主。结果 治愈229例，占88．1％，好转23例，占8．8％，无效8例，占3．1％，总有效率为96．9％。结论 对能一次性切除者，首选手术治疗；对一些难治性的血管瘤应采用综合治疗；头面深部的血管瘤可用动脉数字减影血管造影（DSA）进行定位诊断并对先天性动静脉畸形进行栓塞治疗有较好的疗效；大部分颌面血管瘤采取局部注射平阳霉素治疗是很有效的手段，对外形的改变最小。     

平阳霉素联合手术治疗儿童口腔颌面部血管瘤临床疗效观察

目的观察局部注射平阳霉素加手术切除治疗儿童口腔颌面部血管瘤的临床疗效。方法对52例口腔颌面部血管瘤患者首先采用平阳霉素、地塞米松、利多卡因混合液进行瘤体多点腔内注射,至瘤体稍发白,经3～5次注射后行手术治疗。对部分未能完全切除或完全切除后可能导致严重继发畸形的患儿,进行术中和术后继续应用平阳霉素治疗。结果 69.23%患者经平阳霉素注射后直接切除治愈,25.00%经术后3～5次注射治愈,显效和好转2例,无效1例。结论应用平阳霉素注射合并手术切除治疗患者血管瘤,术中出血少,手术风险低,提高了患者血管瘤的治愈率。     

平阳霉素治疗浅表血管瘤临床分析

本文分析22例平阳霉素治疗浅表血管瘤的临床资料。经随访,结果表明,达到较好临床效果,治愈好转率95%以上,认为该方法简便易行,时间短,痛苦小,副作用轻,经济实用,可推荐临床应用。     

平阳霉素瘤腔内注射结合手术治疗颌面部血管瘤的护理

目的介绍平阳霉素瘤腔内注射结合手术切除治疗口腔颌面部血管瘤的护理措施。方法对22例患者口腔颌面部血管瘤瘤体内注射平阳霉素结合手术切除,术前针对不同患者的病情及其家属的心理状态,做好心理护理及健康教育,使他们了解治疗过程,消除心理顾虑,积极配合治疗;术后护理重点做好出血、感染、平阳霉素疗效的观察及其防治护理。结果10例治愈,8例基本治愈,3例好转,1例血管瘤侧颜面部肿胀。少数患者有发热和胃肠道不适,无患者出现肺部症状、并发局部溃疡坏死或过敏反应。结论平阳霉素瘤腔内注射结合手术切除治疗口腔颌面部血管瘤应加强术前、术后护理,及早防治各种并发症的发生,这样有利于提高治疗效果。     

平阳霉素治疗小儿颌面部血管瘤的护理

小儿颌面部血管瘤并不少见，因局部解剖结构的特点，手术治疗有一定的困难，易导致面部畸形，给患者造成终身的精神伤害。2004年1月—2007年2月，我们采用平阳霉素局部注射治疗婴儿颌面部血管瘤28例，疗效满意。现将护理体会报道如下。     

平阳霉素联合地塞米松治疗海绵状血管瘤90例疗效分析

我科自1992年开始采用平阳霉素联合地塞米松治疗海绵状血管瘤90例,疗效较为满意,现报告如下。1 资料和方法1.1 一般资料本组90例颌面部海绵状血管瘤患者中,男性38例,女性52例;年龄最大的为58岁,最小的为3个月,     

平阳霉素治疗颌面部血管瘤的临床疗效分析

目的了解平阳霉素治疗颌面部血管瘤的疗效。方法通过对76例颌面血管瘤采取平阳霉素局部注射。结果总有效率97．4％。     

平阳霉素联合普萘洛尔治疗婴幼儿颌面部血管瘤疗效分析

目的：探讨平阳霉素联合普萘洛尔治疗婴幼儿颌面部血管瘤的临床疗效。方法：我院2008年5月至2012年5月期间收治的45例婴幼儿血管瘤患者,其中瘤内注射平阳霉素联合口服普萘洛尔治疗组24例,单纯瘤内注射平阳霉素治疗组21例。采用SPSS13．0软件分析,比较两组的的临床疗效和不良反应。结果：平阳霉素联合普萘洛尔组的治疗效果优于平阳霉素组,差别具有统计学意义（Z=-2．391,P〈0．05）;两组不良反应率分别为12．5％、9．5％,差别无统计学意义（Х^2=0000,P〉0．05）。结论：瘤内注射平阳霉素联合口服普萘洛尔治疗领面部血管瘤的临床疗效显著,不良反应轻,是治疗婴幼儿血管瘤的较好方法。     

Protocol for the treatment of haemangiomas and/or vascular malformations

When facing any vascular lesion present in the first moments of life, it is necessary to determine whether one is dealing with a tumour or a vascular malformation, given the different evolution of both processes and, hence, the different treatments they require. Diagnosis is basically clinical, based on a correct anamnesis and a detailed physical exploration. The first thing is to establish whether the lesion was present at birth and has changed size significantly, which would lead one to think of a haemangioma or, on the contrary, whether it is congenital and of very slow growth, such as vascular malformations. Facing dubious lesions, it is recommendable to carry out a biopsy with immunohistochemistry for the GLUT-1 antibody, specific to haemangiomas. Amongst the image tests, the first choice is usually ecography-Doppler, which makes it possible to determine whether the lesion is of high or low flow and to distinguish whether one is dealing with a haemangioma or a vascular malformation. Depending on the type of lesion, its localisation and degree of affectation it might be necessary to carry out radiography, magnetic resonance, phlebography, angio-resonance, arteriography or lymphoscintigraphy to complete the study. In more particular cases, such as multiple haemangiomatosis, it is necessary to carry out an hepatic echography, blood concealed in faeces, gastroscopy and colonoscopy, as well a determination of thyroid hormones; and in venous or combined extensive malformations, a haemogram and coagulation tests. On the other hand, the possible repercussions on other organs make a multidisciplinary approach essential, with the participation of different specialists. Due to the wide spectrum covered by vascular anomalies, treatment must be individualised.     

Arnold-Chiari畸形手术中眼内压的变化

目的 观察Arnold-Chiari畸形手术中眼内压的变化.方法 选择20例择期行Arnold-Chiari畸形手术的患者,分别于全身麻醉后5 min(T0)、俯卧位后5 min(T1)、俯卧位后30 min(T2)、俯卧位后60 min(T3)、手术结束前俯卧位(T4)、恢复平卧位5 min(T)、平卧位后30 min(T6)测量眼内压,同时记录各时间点平均动脉压(MAP)、心率(HR)、呼气末二氧化碳分压(PETCO2)的变化.俯卧位时,患者头部均采用颅骨钉固定于头架上.结果 术中各时间点MAP、HR、PETCO2比较差异均无统计学意义(P＞0.05);患者T1[(20.9±2.5)mm Hg(1mm Hg =0.133 kPa)]、T2[(17.7±1.7)mm Hg]、T3[(23.9±2.4)mm Hg]、T4[(26.3±1.0)mm Hg]眼内压较T0[(9.5±1.5)mm Hg]明显升高(P＜0.05),T3较T2明显升高(P＜0.05),T4较T3明显升高(P＜ 0.05);T5(18.6±1.8)mm Hg]较T4明显降低(P＜0.05),但相对T0仍明显升高(P＜ 0.05);T6[(10.3±1.7)mm Hg]基本恢复到T0水平;颅骨钉的置入可能有一过性加剧眼内压升高的可能,T1眼内压较T2明显升高(P＜0.05).结论 ArnoldChiari畸形手术中随着体位改变患者眼内压逐渐升高,颅骨钉的置入可使眼内压一过性升高.     

Sclerosing treatment of vascular malformations

Traditional sclerotherapy with liquid sclerosants has been used for many years in the treatment of venous, lymphatic and low flow vascular malformations; it is efficient only with those vascular malformations of reduced size as a pre or post-operational complement. The use of liquid sclerosants has the limitations of their dilution and progressive inactivation in a great haematic volume, the irregular distribution of the sclerosant on the endothelium, the handling of the sclerosant once injected and its imperceptibility to the echo-Doppler. In their turn, both ethanol and sodium morrhuate - the most habitually employed sclerosants - produce important secondary effects. On the contrary, the use of sclerosants, specifically polidocanol in microfoam form, significantly improves the procedure, since the microfoam displaces the blood instead of mixing and diluting itself in it, thus facilitating an homogeneous distribution of the sclerosant over the endothelial surface. Finally, the echogenicity of the microbubbles, which makes them directly visible, together with their manageable consistency, means that it can be distributed more easily throughout the treated area. We comment on our experience with 50 patients with venous or low flow vascular malformations, treated with this new form of sclerosant. Similarly, the use of OK-432 (picibanil) - as the recommended sclerosant treatment in lymphatic vascular, especially macrocystic, malformations - is reviewed and its protocol given.     

Surgical treatment of vascular malformations

In spite of the numerous advances made over the last two decades, the treatment of congenital vascular malformations continues to be one of the greatest enigmas facing modern medicine. There are no clear criteria concerning the indications to be followed, and even less concerning the most appropriate therapeutic procedures for each type of lesion. The results of a strictly surgical approach are discouraging and today it is accepted that congenital vascular malformations should be attended to and treated by multidisciplinary units, combining the efforts of all the specialists involved in its treatment. This paper reviews the general principles of surgical treatment of congenital vascular malformations, without losing sight of the fact that the traditional role of isolated surgery in the treatment of congenital vascular malformations has been replaced by a multidisciplinary approach to this type of lesions, making it possible to integrate embolization, sclerotherapy and surgery to improve the results. The combination of these techniques reduces the risk and complications that existed when they were applied in an isolated form. Thus, surgical treatment should not be considered as an independent tool of treatment but as a therapeutic weapon integrated in the ensemble of measures directed at improving the quality of life of the patient with a congenital vascular malformation.