平阳霉素局部注射治疗婴幼儿真性血管瘤和血管畸形应注意的问题

目的：探讨提高平阳霉素治疗婴幼儿真性血管瘤和血管畸形过程中疗效的方法。方法：在应用平阳霉素治疗婴幼儿真性血管瘤和血管畸形200余例后，对适应证的选择、药物剂量和浓度、注射方法和观察期、注药后注意事项进至了总结。结果：认为婴幼儿真性血管瘤和血管畸形应及早治疗，药物浓度最好控制在1mg/1.5ml以内，药物应注入瘤体实质内，观察周期以3周为妥。结论：使用平阳霉素局部注射治疗婴、幼儿真性血管瘤和血管畸形，应依据病变的分型、年龄、所欲达到的目的等而区别对待，方能获得理想的效果。     

微创疗法治疗舌下腺囊肿的临床效果评价

目的探讨应用平阳霉素联合地塞米松治疗舌下腺囊肿的疗效。方法应用平阳霉素及地塞米松治疗舌下腺囊肿患者120例,平阳霉素1支（8mg）,地塞米松1支（5mg）加入到2%盐酸利多卡因3ml中,混合液终浓度为每1ml溶液中含平阳霉素2mg、地塞米松1.25mg,囊肿腔内注射,酌情给药。7d注射1次,3次为1疗程。囊肿完全消失者为治愈;囊肿缩小,但不能完全消失或需要手术辅助治愈者为好转。结果治愈109例（90.8%）,好转11例（9.2%）。结论应用平阳霉素联合地塞米松局部注射治疗舌下腺囊肿,可作为不能耐受手术治疗患者的首选。     

平阳霉素联合曲安奈德治疗婴幼儿口腔颌面部血管瘤疗效观察

口腔颌面部血管瘤是口腔科的一种常见多发病，多发生于婴幼儿出生时或出生不久，是一种先天性良性肿瘤或血管畸形，它占全身血管瘤的60％。其中大多数发生于颜面皮肤，皮下组织及口腔粘膜等，可造成颜面部畸形、功能障碍。且可引发感染及出血等严重并发症。我科采用平阳霉素联合曲安奈德局部注射治疗婴幼儿口腔颌面部血管瘤取得良好疗效，现报告如下。     

Nd：YAG激光联合平阳霉素治疗口腔血管瘤

目的 观察Nd：YAG激光联合平阳霉素（博来霉素A5）治疗口腔血管瘤的疗效。方法 100例口腔血管瘤患者，随机分为激光、平阳霉素联合治疗组与单纯激光治疗组，每组各50例；采用波长1064nmNd：YAG激光治疗；联合治疗组，先于瘤体内注射平阳霉素，每次用量＜8mg，多次注射总量＜40mg；待瘤体明显变薄后，用Nd:YAG激光“散点式”或“栅栏状”照射，激光输出功率10－20W，时间1－2s，光纤头距病灶0－2－4．0cm；单纯激光治疗组仅用相同的激光治疗方法。治疗后随访6个月；对两组治疗有效率做统计学分析，显著性检验采用χ^2检验。结果 联合治疗组治疗有效率为96％，平均疗程45天；单纯激光组治疗有效率为72％，平均疗程92天。两组比较差异有显著意义（P＜0．01）。结论 激光联合平阳霉素治疗口腔血管瘤是一种安全、有效的方法。     

平阳霉素联合地塞米松注射治疗低流量血管畸形的临床应用

目的 探讨平阳霉素联合地塞米松注射治疗低流量血管畸形的疗效.资料与方法 搜集2006年12月至2009年7月应用平阳霉素碘化油混合乳剂联合地塞米松注射治疗低流量血管畸形患者8例,均采用直接穿刺造影观察病变范围、大小、静脉引流,明确诊断后行畸形血管内注射药物,观察疗效及并发症.结果 经6～12个月随访,1例治愈,4例基本治愈,有效3例.未出现并发症.结论 平阳霉素混合液经皮注射治疗低流量静脉血管畸形是一种高效、安全的治疗方法.     

平阳霉素联合曲安奈德治疗婴幼儿腔颌面部血管瘤疗效观察

口腔颌面部血管瘤是口腔科的一种常见多发病,多发生于婴幼儿出生时或出生不久,是一种先天性良性肿瘤或血管畸形,它占全身血管瘤的60%[1].其中大多数发生于颜面皮肤,皮下组织及口腔粘膜等,可造成颜面部畸形、功能障碍,且可引发感染及出血等严重并发症.我科采用平阳霉素联合曲安奈德局部注射治疗婴幼儿口腔颌面部血管瘤取得良好疗效,现报告如下.     

平阳霉素局部注射治疗头面部血管瘤

我们自1997年10月～2000年2月采用平阳霉素局部注射治疗头面部血管瘤10例,取得良好效果,现报告如下。1　临床资料11　一般资料　本组10例均为我院门诊或住院患者,其中男6例,女4例,最小年龄1岁,最大年龄46岁;面部血管瘤2例,颊粘膜血管瘤1例,鼻中隔血管瘤2例,舌、唇多发性海绵状血管瘤1例,咬肌海绵状血管瘤1例,上睑海绵状血管瘤2例,额部皮肤血管瘤1例;发病时间最长20ａ,最短1ａ,疗程最长5周,最短3周;疗程用药剂量最大40ｍｇ,最小18ｍｇ。12　典型病例　男,46岁。持续性右侧鼻塞,伴反复鼻出血4个月,于1999年2月21日入院。检查右鼻腔充满粉红色…     

颌面部血管瘤的介入栓塞治疗

目的 探讨颌面部血管瘤的最佳治疗方法。材料和方法 采用Ｓｅｌｄｉｎｇｅｒ方法，用明胶海绵、弹簧圈及线段选择性栓塞血管瘤的供血管，瘤体内局部注射平阳霉素。结果 ４例栓塞加局部注射后，供血动脉完全闭塞，瘤体异常血管团消失。局部肿块明显缩小、硬化或消失。结论 颈外动脉栓塞加局部注射平阳霉素联合运用是安全、可靠，具有根治作用的治疗颌面部血管瘤之方法。     

药物治疗血管瘤不良反应

平阳霉素、地塞米松、利多卡因联合治疗血管瘤，在临床已得到较为广泛的应用，其不良反应的发生较少报道。我科在2004～2009年治疗时出现23例不良反应，报告如下。 1 临床资料 1．1 一般资料：我科2004-Ol～2009-12使用平阳霉素、地塞米松、利多卡因联合治疗血管瘤共计672人次，年龄范围4月～6岁，平均年龄11．7月。其中头部301人次、躯干部326人次，四肢（关节处除外）37人次，会阴部8人次。     

颌面部血管瘤的介入栓塞治疗(附4例报告)

目的探讨颌面部血管瘤的最佳治疗方法。材料和方法采用 Seldinger 法,用明胶海绵、弹簧圈及线段选择性栓塞血管瘤的供血血管,瘤体内局部注射平阳霉素。结果 4例栓塞加局部注射后,供血动脉完全闭塞,瘤体异常血管团消失。局部肿块明显缩小、硬化或消失。结论颈外动脉栓塞加局部注射平阳霉素联合运用是安全、可靠,具有根治作用的治疗颌面部血管瘤之方法。     

MRA在周围软组织血管瘤和血管畸形中的应用

目的探讨MRA在周围软组织血管瘤和血管畸形中的应用价值。方法回顾性分析61例血管瘤和血管畸形动脉、静脉磁共振血管成像表现。结果13例血管瘤中7例病灶内出现增多且逐渐变细的细小动脉,2例合并有动-静脉瘘形成,6例病灶内未见血管显示。48例血管畸形中35例病变区动、静脉显影,1例仅见动脉显影。动脉成像23例表现为动脉受压变细,5例可见动脉畸形。静脉成像25例显示浅静脉畸形,其中13例合并深静脉畸形,2例仅显示深、浅静脉增多、增粗。8例动、静脉成像均可见动-静脉瘘形成。12例病变区未见血管显影。结论MRA对周围软组织血管瘤和血管畸形的诊断和鉴别有重要价值。     

内结扎合并平阳霉素注射治疗颌面部巨大血管瘤临床分析

目的：综合分析对颌面部巨大血管瘤采取瘤体内结扎合并平阳霉素注射的临床效果。方法：对25例发生于颌面部的巨大血管瘤采取瘤内缝线纵横结扎,将之分割成许多互相隔断的小区,再进行平阳霉素的多次注射治疗。结果：本组25例患者,治愈19例,占76%,好转6例,占24%,无效0例。结论：瘤体内结扎合并平阳霉素注射治疗具有疗程缩短,疗效可靠,操作简便等优点,是颌面部巨大血管瘤的理想治疗方案,尤其适合于单纯平阳霉素注射无效或不宜手术的病例。     

经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤

目的：探讨CT引导下经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤的疗效及安全性。方法：选择肝海绵状血管瘤患者34例,瘤体直径为3．2～12．0cm,采用CT引导下经皮穿刺,注射平阳霉素碘油乳剂治疗肝海绵状血管瘤,注射剂量为6～20ml。所有病例术后3个月、半年、1年各复查CT1次。结果：经皮注射平阳霉素碘油乳剂后,29例血管瘤瘤体内碘油沉积良好,5例PLE不能完全充盈瘤灶。术后3～6个月,全部病例瘤体均有明显缩小,其中缩小达80％以上者18例,〉50％者14例,缩小〈50％者2例。本组病例未出现肝脏坏死、胆管毁损、胆囊坏死穿孔、急性胰腺炎等严重并发症。结论：经皮注射平阳霉素碘油乳剂治疗肝海绵状血管瘤是一种操作简便且安全高效的治疗方法。     

软组织血管瘤介入治疗

目的 分析软组织血管瘤的影像诊断和鉴别诊断,以及介入治疗经验.方法 29例患者,1例婴儿左侧面部巨大毛细血管瘤行左侧颈外动脉造影,未行栓塞治疗;26例静脉畸形中,13例行穿刺造影和无水乙醇加平阳霉素和碘油乳剂硬化治疗;1例左肘和1例右小腿肌肉蔓状血管瘤(AVF和AVM)使用真丝线段或PVA颗粒行末梢动脉栓塞,使用钢圈行主干栓塞.结果 1例要儿面部巨大毛细血管瘤供血动脉增粗,染色明显,引流静脉增粗.10例静脉畸形的X线平片显示静脉石;13例MRI显示T_1等信号,T_2高信号,增强有强化;3例CT示血管瘤软组织肿块;9例初诊彩超显示血管瘤内异常血流.行血管瘤造影18例,成功16例,其中行血管瘤硬化治疗13例,注射1～5次,无水乙醇碘油乳剂硬化治疗5例,痊愈1例,好转4例; 无水乙醇加平阳霉素和碘油乳剂治疗8例,其中6例痊愈,2例好转.结论 软组织血管瘤正确的影像诊断可协助治疗方案的制订.根据血管畸形的血流情况可采用不同的介入方法.     

肢体及颌面部低流量血管畸形的介入治疗

目的 探讨经皮穿刺硬化治疗肢体及颌面部低流量血管畸形的可行性和临床疗效。方法 回顾性分析1998～2002年来在我院接受介入治疗的17例肢体及颌面部低流量血管畸形患者的治疗经过和疗效。本组患者应用直接穿刺、动脉造影 穿刺或动脉栓塞 穿刺等不同方法，向瘤体内推注乙醇或碘油 平阳霉素行硬化治疗。结果 17例中11例经一次硬化治疗治愈，5例行多次硬化治愈，1例会阴部低流量血管畸形患者因过度栓塞，引起局部肌肉坏死，行局部坏死组织挖除并植皮治疗。结论 肢体及颌面部低流量血管畸形的治疗难度比较大，但经皮穿刺硬化治疗是一种有效、安全可靠的治疗方法。     

MRI characteristics and classification of peripheral vascular malformations and tumors

Vascular malformations and tumors comprise a broad spectrum of lesions that can cause significant morbidity and even mortality in children and adults. Classification of vascular malformations into high flow and low flow has significant impact on management since the main treatment of the former is transarterial embolization and the later percutaneous sclerotherapy. Magnetic resonance imaging (MRI) is a noninvasive effective tool for imaging and classification of vascular malformations based on the presence of lobulated masses, signal voids, and hemodynamic flow characteristics. MRI also provides details about anatomic extent of the lesion, proximity to vital structures, and involvement of multiple tissue planes. The prototype of vascular tumors is infantile hemangioma with its typical involution after a proliferative phase during infancy. Hemangioma appears as a distinct intensely enhancing soft tissue mass with enlarged feeding arteries and draining veins. Less common vascular tumors include congenital hemangioma, kaposiform hemangioendothilioma, angiolipoma, angiosarcoma, and hemangiopericytoma. There was no funding for this project.     

Soft-tissue vascular anomalies: utility of US for diagnosis

PURPOSE: To determine the ultrasonographic (US) features that distinguish soft-tissue hemangioma from vascular malformation and one type of malformation from another. MATERIALS AND METHODS: Eighty-seven vascular anomalies were evaluated by means of US. Lesions were assessed for the presence of solid tissue and abnormal arteries, veins, or cysts. Vessel density, peak flow velocities, and resistive indexes were compared. RESULTS: There were 49 hemangiomas and 38 vascular malformations. A significantly greater proportion of hemangiomas (48 of 49) compared with vascular malformations (zero of 38) consisted of a solid-tissue mass (P < .001). Vessel density was comparable for hemangioma and arteriovenous malformation (AVM) but significantly greater compared with the other vascular malformations (P < .001 in each case). No differences in mean arterial peak velocity were detected between hemangiomas and malformations. Mean venous peak velocity was significantly higher for AVM than for other vascular malformations and hemangioma. Mean resistive index was greater for lymphatic malformation than for hemangioma or AVM. Abnormal veins, arteries and veins, or cysts were univariate predictors for distinguishing between venous, arteriovenous, and lymphatic malformations (P < .001 in all cases). Solid-tissue mass was the only multivariate predictor for differentiating hemangioma from vascular malformation (likelihood ratio test = 109.8, P < .001). CONCLUSION: US can be used to distinguish hemangioma from vascular malformation and detect arterial flow. These distinctions are critical for subsequent management and assessing prognosis.     

Imaging findings of vascular lesions in the head and neck

Vascular lesions of the head and neck include vascular neoplasms, vascular malformations, and hypervascular lesions, derived from nonvascular soft-tissue elements. We retrospectively evaluated magnetic resonance imaging and computed tomography images of vascular lesions located in the head and neck. Twelve patients (seven males, five females) aged 1–68 years (mean age, 35.25 years) were included in this study. Most of the vascular lesions in our study were histologically diagnosed. The lesions were as follows: a hemangioma located in the parotid space (n=1); a hemangioendothelioma located in the parotid space (n=1); a hemangiopericytoma located in the larynx (n=1); a juvenile angiofibroma located in the nasopharynx (n=1); a glomus tumor located in the carotid bifurcation (n=1); venous malformations located in the parapharyngeal space, the pterygoid area, the orbital space, and the larynx (n=4); lymphatic malformations located in the parotid space and the supraclavicular area (n=2); and an arteriovenous malformation located in the infratemporal fossa (n=1). We present rare vascular lesions of the head and neck, which have typical radiological findings.The International Society for the Study of Vascular Anomalies (ISSVA) classification system provides an approach based on histopathology, clinical course, and treatment (1). The ISSVA classification system divides vascular anomalies into two primary biological categories: vascular neoplasms and vascular malformations. Vascular neoplasms include infantile hemangioma, congenital hemangioma, hemangioendothelioma, tufted angioma, angiosarcoma, and dermatologic acquired vascular neoplasms. Vascular malformations include low-flow malformations (capillary, venous, and lymphatic), high-flow malformations (arterial malformation, arteriovenous malformation, and arteriovenous fistula), and combined malformations (i.e., venolymphatic malformation). Vascular neoplasms have increased endothelial cell turnover (i.e., they proliferate and undergo mitosis), whereas vascular malformations are structural abnormalities of the capillary, venous, lymphatic, and arterial system that grow in proportion to the child (1). There are also lesions, which demonstrate marked neovascularity despite being derived from nonvascular soft-tissue elements. These hypervascular lesions should be distinguished from the vascular endothelial cell-derived neoplasms existing in the ISSVA classification system.We retrospectively evaluated magnetic resonance imaging (MRI) and computed tomography (CT) images of vascular lesions located in the head and neck, between 2005 and 2008 in our institution. Twelve patients (seven males, five females) aged 1–68 years (mean age, 35.25 years) were included in this study. Informed consent was obtained from all patients. We identified two vascular neoplasms existing in the ISSVA classification sytem: a congenital hemangioma and a hemangioendothelioma. In addition, we identified a hemangiopericytoma, a juvenile angiofibroma, and a glomus tumor, which are hypervascular lesions derived from nonvascular soft-tissue elements. There are four venous malformations, two lymphatic malformations, and an arteriovenous malformation in our study. Most of these vascular lesions were histologically diagnosed. Examinations were performed by a 16-slice CT and a 1.5 Tesla magnetic resonance scanner.     

脑血管畸形的MRI及MRA诊断

目的：研究脑动静脉畸形与海绵状血管瘤的ＭＲＩ及ＭＲＡ特征，评价不同的成像方法对脑血管畸形的诊断价值。材料与方法：对２１例脑动静脉畸形及６例海绵状血管瘤分别作了常规ＭＲ成像及ＭＲ血管成像，ＭＲＩ采用ＳＥＴ１和Ｔｕｒｂｏ ＳＥ Ｔ２加权序列，ＭＲＡ采用２Ｄ－ＦＬＡＳＨ及３Ｄ－ＦＩＳＰ序列，６例海绵状血管瘤ＭＲＡ仅使用２Ｄ－ＦＬＡＳＨ序列。所有成像以环形激化头线圈在１．０Ｔ ＭＲ仪上完成。结果：Ｔ１及Ｔ     

Facial hemangioma and hemispheric migration disorder: presentation of 5 patients

BACKGROUND AND PURPOSE: The association of cortical organization disorders with facial hemangiomas or vascular malformations has been described in only a few reports. The purpose of this study was to show the close association of these cutaneous anomalies with cortical dysplasias and intracranial vascular abnormalities. MATERIALS AND METHODS: Five patients, all women, with cutaneous vascular abnormalities, 4 with hemangioma and 1 with vascular malformation, were studied with MR and MR angiography. RESULTS: All 5 of the patients showed cortical dysplasia. The cutaneous lesions involved the left frontal region, ipsilateral to the cerebral hemisphere with cortical dysplasia, in all of the patients. Four patients had seizures that responded well to antiepileptic drugs. Hemispheric hypoplasia was associated with the cortical dysplasia in all 5 of the patients. Arterial abnormalities were found in all of the patients, consisting of aplasia of the ipsilateral internal carotid artery in 2, persistence of the trigeminal artery in 2, persistence of both proatlantal arteries and double kinking in the internal carotid artery in 1, and origin of both anterior cerebral arteries from the same internal carotid in all 5 of the patients, 1 of whom also showed an intracavernous anterior cerebral artery origin of the same side of the hemispheric hypoplasia and polymicrogyria. Seizures and mild psychomotor delay could be caused by the cortical dysplasia and the hemispheric hypoplasia. CONCLUSIONS: The presence of many congenital vascular abnormalities in this series suggests that facial hemangioma and vascular malformations may be in close relationship with cortical and vascular abnormalities. The reason that the vascular and cortical abnormalities occurred in the left side in all 5 of the patients and the mechanism underlying the association of both malformations are unclear. A genetic origin is suggested.