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血管瘤(hemangioma)是婴幼儿最常见的良性肿瘤,好发于头、面、颈部,发生于口腔颌面部的血管瘤占全身血管瘤病变的60%以上.由于血管瘤具体的发病机制不清,且不同类型血管瘤的病理演变、临床经过有很大不同,故治疗困难.外科手术曾作为血管瘤治疗的主要方法,但由于血管瘤有自然消退的可能,故有学者主张对血管瘤可等待其消退或用非手术方法治疗.目前认为,位于重要部位、生长迅速及影响美容有可能给患者带来严重心理障碍的血管瘤应早期治疗,特别是适宜的药物治疗可促使血管瘤早期消退而达到治疗目的.临床在这方面进行了大量的尝试,取得了很大的进展.现综述如下.     

平阳霉素局部注射治疗颌面部血管瘤87例报告

目的探讨平阳霉素治疗血管瘤的疗效.方法用平阳霉素局部注射治疗口腔颌面部血管瘤87例进行疗效观察.结果对血管瘤治疗总有效率92.0%,其中对杨梅状血管瘤、海绵状血管瘤及混合性血管瘤的有效率分别为100%、96.1%、94.4%.结论平阳霉素局部注射治疗血管瘤疗效肯定,尤其可作为杨梅状血管瘤、海绵状血管瘤治疗的首选方法.     

皮肤幼年性血管瘤的处理

过去对脉管疾病的描述往往将血管瘤和脉管畸形相混淆，从而导致不恰当的治疗及医学文献记录的矛盾。Mulliken和Glowacki系统描述了血管瘤和脉管畸形的差别，认为血管瘤是真正的肿瘤，在组织学上表现为细胞增殖。在治疗方面文献报道也存在不同，有人认为血管瘤可以完全自行消退，而部分文献却主张对病变进行干预。最近．对血管瘤自然病程研究增多，并对血管瘤是观察还是干预的选择进行了讨论，设计了安全有效的治疗方案。该文分2部分，第1部分结合新近文献，综述血管瘤的诊断及其自然病程，并与旧的文献作了比较。第2部分介绍了血管瘤是治疗还是观察的原则，推荐治疗方法，并着重论述了外科技术。     

婴幼儿腮腺区血管瘤治疗的研究进展

血管瘤是婴幼儿期常见的具有自愈倾向的疾病,其治疗存在争议。相对于其他部位,腮腺区血管瘤具有体积较大和影响患儿外貌等特点。血管瘤常见的治疗方法有保守观察,口服激素、干扰素,激素、抗肿瘤药物局部注射及手术治疗等等。本文就以上几种治疗方法从疗效和并发症等方面作一综述。     

强的松龙与鱼甘油酸钠混合剂治疗婴幼儿血管瘤的研究

本文报告了用鱼肝油酸钠与醋酸强的松龙配成混合剂局部注射治疗婴幼儿皮肤血管瘤82例,并与单用强的松龙治疗24例对照研究,寻求保守治疗婴幼儿口面头颈部血管瘤的好方法.结果,治疗组有效率100%,痊愈率46.3%,与对照组相比,P<0.005.治愈率明显提高.该混合剂局部注射治疗血管瘤简便、可靠.混合剂治疗组按血管瘤类型疗效统计:毛细血管瘤和海绵状血管瘤明显高于混合型血管瘤(P<0.005).并对混合剂治疗皮肤血管瘤的机理等问题进行了讨论.     

头颈部血管瘤治疗适应证的探讨

血管瘤是婴幼儿期常见的良性脉管肿瘤,60%～70%发生于头颈部。血管瘤的治疗方法多种多样,但迄今尚无一种方法适合于所有类型血管瘤的治疗。作者结合临床经验和文献复习,提出了头颈部血管瘤的治疗适应证及方法选择。认为较小、处于稳定期、消退期和消退完成期的血管瘤适于随访观察,增殖期血管瘤需按照循序渐进的原则进行积极治疗,表浅血管瘤可采用咪喹莫特软膏局涂、单纯激光或激光 激素治疗;深部血管瘤可采用瘤内注射激素、平阳霉素治疗;多发性血管瘤、重症血管瘤或生长快速的血管瘤首选口服激素治疗,激素治疗无效时,采用干扰素-α2a皮下注射;手术治疗不能作为早期血管瘤的首选治疗,而是用于血管瘤后期残存病变的切除或修整。     

细胞凋亡抑制基因bcl-2和survivin在血管瘤不同时期的表达

目的:探讨血管瘤自然消退过程与细胞凋亡的关系.方法:收集血管瘤及血管畸形标本63例,均经病理证实;所有患者均未经过激素或其他药物治疗.其中血管瘤44例,按照组织学特征将其分为增殖期23例,退化期21例;血管畸形19例.每例标本采用SABC法免疫组化,检测bcl-2、survivin 2种细胞凋亡抑制基因的蛋白表达,同时以8例正常皮肤组织作为对照.采用SPSS11.0软件包行×列表卡方检验.结果:血管瘤增殖期和退化期的bcl-2表达不同,具有显著性差异(P＜0.01);而survivin的表达无显著性差异(P＞0.05).结论:Bcl-2在血管瘤增殖期血管内皮细胞的高表达与退化期表达有显著性差异.提示该基因可能在血管瘤增殖期抑制内皮细胞凋亡方面发挥作用;而survivin在血管瘤增殖期内皮细胞的高表达,与退化期表达无显著性差异,提示该基因与血管瘤的自然消退关系不大.     

大剂量强地松冲击疗法治疗婴幼儿血管瘤25例报告

婴幼儿血管瘤是常见的多发病之一,至今尚无很好的治疗方法。硬化剂注射、激光及冷冻治疗,也不能彻底治愈。特殊部位血管瘤,如眼周、口周及鼻翼、耳廓等处,易留下严重畸形和功能障碍。婴幼儿血管瘤发育迅速,处于未成熟期,对大剂量强地松治疗十分敏感。作者使用大剂量强地松治疗婴幼儿血管瘤效果     

聚多卡醇治疗血管瘤及脉管畸形研究进展

血管瘤与脉管畸形是临床常见病,头颈部发病率约40%~60%,不仅造成颜面部畸形,影响美观,还可影响吞咽、呼吸等生理功能,严重者可能因感染、溃疡、压迫呼吸道等危及生命。复杂血管瘤与脉管畸形的治疗,一直是临床上面临的难题与挑战,目前主要治疗方法有手术切除、硬化治疗、激光治疗、介入治疗等,其中硬化治疗不仅在静脉畸形、淋巴管畸形等疾病中得到广泛应用,而且逐渐应用于血管瘤、化脓性肉芽肿等疾病的治疗。作为硬化治疗的药物—硬化剂,聚多卡醇在临床上的应用越来越广泛。本文从硬化原理、临床应用、安全性及有效性等方面,对聚多卡醇治疗血管瘤及脉管畸形的相关背景及研究进展做一综述。     

颈动脉造影在口腔颌面外科的应用

目前颈动脉造影的方法较多,它对于了解颅脑.颌面,颈部某些病变的血管形态、功能,病理和生理情况,以及研究正常人颈动脉的分支和行程都有较重要的价值.在口腔颌面外科有着广泛的用,是值得利用的一种方法。一、适应症1.头颈部血管瘤和动静脉畸形的诊断和术前制定治疗计划.颈动脉造影可以显示血管瘤的大致范围,部位.类型:也可显示血管瘤的血供及回流。这样就     

普萘洛尔治疗溃疡性婴幼儿血管瘤18例临床分析

目的：评价普萘洛尔治疗溃疡性婴幼儿血管瘤的临床疗效和安全性。方法：选择2009年6月—2015年10月于中国医科大学附属口腔医院收治的18例并发溃疡的婴幼儿血管瘤患者,其中男7例,女11例。所有患儿均口服普萘洛尔,按1.0～1.5 mg/kg给药,每天1次顿服,连续给药3～12个月。每周复诊,至溃疡面完全愈合后改为每月复诊。动态观察并记录血管瘤大小、质地和颜色变化,溃疡面愈合情况、愈合时间,治疗结束或瘤体消退后有无瘢痕遗留。通过治疗期间出现的不良反应进行安全性评价。结果：18例患儿溃疡愈合时间为2~9周,平均3.96周;治疗时间为3~12个月,平均8个月;随诊时间8~24个月,平均17.8个月。2例患者遗留瘢痕。发现心率减慢、腹泻、溢奶、睡眠改变等不良反应,均未做特殊处理,未发生严重全身或局部不良反应。结论：口服普萘洛尔治疗溃疡性婴幼儿血管瘤能使溃疡面在短期内愈合,使血管瘤明显缩小,不良反应轻微,可作为治疗溃疡性婴幼儿血管瘤的首选方法。     

Use of propranolol for the treatment infantile hemangiomas in the maxillofacial region

Propranolol has been used successfully in a limited number of children with infantile hemangiomas (IHs). This study describes the efficacy and adverse effects of propranolol in IH. Seventy-one infants with IHs were treated with oral propranolol, administered at a dose of 2 mg/kg/day, for at least 12 weeks. A photograph-based severity scoring assessment was performed by five observers to evaluate efficacy, utilizing a score of 10 as the original IHs before treatment and 0 as completely normal skin. The mean of the five independent measurements was used in the analysis. Propranolol was a rapid and effective treatment for IHs at 4 weeks (P < 0.001), at 8 weeks (P < 0.001 compared with the value at 4 weeks), at 12 weeks (P < 0.05 compared with the value at 8 weeks), and thereafter up to 32 weeks (P < 0.01 compared with the value at 16 weeks). The response of IHs to propranolol was similar regardless of gender, age at the onset of treatment, type of involvement (local and extended), facial segments affected, special locations (eyelid, nasal tip, and parotid regions), ulceration, and depth of IHs. In the series of patients in this study, oral propranolol at a dosage of 2 mg/kg/day was a well-tolerated and effective treatment for IHs.     

颌面部血管瘤合并动静脉畸形：病例报告及文献复习

血管瘤和血管畸形虽是婴幼儿的常见病,但血管瘤能否与动静脉畸形合并发生却一直存在争议。作者报告1例颌面部巨大、多发性血管瘤伴动静脉畸形的新生儿病例,经α-干扰素皮下注射治疗,血管瘤基本消退,而动静脉畸形依然存在。该病例报告证实,血管瘤可与动静脉畸形并存发生,且干扰素治疗重症血管瘤具有显著疗效。     

局部外用β受体阻滞剂治疗婴幼儿血管瘤的临床应用研究进展

血管瘤是婴幼儿最常见的良性肿瘤。根据部位、大小、范围、深度、分期、对患儿功能和心理的影响等因素不同,以局部外用和系统用药为主,辅以激光或局部药物注射。目前口服普萘洛尔是治疗浅表性血管瘤的一线药物,然而局部外用β受体阻滞剂更易于被患儿家长接受,其使用人数逐步增多。本文就近年来报道的有关β受体阻滞剂治疗婴幼儿血管瘤的研究现状进行综述,为婴幼儿血管瘤的临床治疗提供理论依据。     

Pyogenic granuloma vs. lobular capillary hemangioma. Histopathological analysis and epidemiology (Venezuela)

A review of the literature is done concerning Pyogenic Granuloma. From two hundred and thirty eight cases of our files. Twenty four cases are separated which are considered histopathologically different and to which the term Lobular Capillary Hemangioma is more applicable. Epidemiologic studies are analyzed and conclusions are established. Pyogenic Granuloma is more a reactive type of lesion of inflammatory nature, while Lobular Capillary Hemangioma separated as an entity is considered a lesion of benign neoplastic nature and vascular origin.     

A rare case of multiple benign tumors of gingiva in a 4 year old child

Hemangioma is a benign proliferation of blood vessels closely simulating normal vessels which may present at any age from birth to old age. Hemangiomas have a typical clinical pattern of rapid proliferation followed by involution, during which these may present with sudden increase in size raising suspicion of malignancy. However, they almost never turn malignant but occasionally may permeate all tissue barriers in an aggressive fashion. Infantile hemangioma is a form of benign vascular tumour presenting commonly in the head and neck region. This case report presents a very rare case of multiple benign lesions of infantile hemangioma in gingiva with a discussion of the relevant diagnostic and treatment modalities.     

普萘洛尔治疗婴幼儿血管瘤的作用机制研究进展

血管瘤是婴幼儿最常见的良性肿瘤,在1岁以下婴儿中的发病率约为10%,其中约60%发生于头颈部。少数重症或多发性血管瘤可继发严重并发症,影响外形、功能甚至危及生命,必须早期进行干预。研究发现,普萘洛尔治疗婴幼儿血管瘤具有良好效果,但其具体作用机制尚不清楚。本文对普萘洛尔治疗血管瘤的作用机制及研究进展做一综述。     

How to use bleomycin A5 for infantile maxillofacial haemangiomas: Clinical evaluation of 82 consecutive cases

Objective

Bleomycin A5 has been reported effective for infantile haemangioma (IH), but the usage and complications were described a little. We have used bleomycin A5 to treat maxillofacial IHs for 15 years. This paper describes the procedures to use bleomycin A5 and avoid its complications based on our clinical practices.

Methods

Bleomycin A5 (8 mg, powder) was mixed with 2% lidocaine (3 ml) and dexamethasone (1 ml, 5 mg), the mixture concentration is 2 mg/ml (bleomycin A5). The drug was given by multiple intralesional injections, with the dosage calculated according to the age of the patient and size of the lesion. Cautions were paid to the drug dosage and concentration, as well as the depth of injection. The patients were also given oral prednisone (2–5 mg/kg every other day) during proliferating stage.

Results

After treatment with bleomycin A5 in appropriate quantity and concentration, injecting depth, all haemangiomas involuted completely, with smaller lesions showing better recovery of skin colour and less scar formation, and no serious side effects happened.

Conclusion

Bleomycin A5 is an effective treatment for IHs. Oral prednisone is necessary for patients at proliferating stage.     

The furcation problem. Current controversies and future directions

Effective management of furcation regions affected by periodontal destruction includes accurate assessment of etiologic factors, careful diagnosis of furcation involvement, and an appropriate plan of therapy. Many forms of therapy have been advocated; most have been designed to allow adequate professional and personal removal of plaque from the furcation. All types of traditional therapy have disadvantages that must be carefully considered by the therapist and the patient. Newer treatment modalities attempt to regenerate periodontal attachment in the furcation. The techniques do not have sufficient controlled documentation at this time to warrant unqualified support, but they appear to be biologically feasible and hold considerable clinical promise. At this time, guidelines for management of a periodontally involved furcation region must stress application of the simplest therapy that is likely to provide clinical stability. Longitudinal data from carefully controlled clinical trials comparing therapy techniques are needed to refine our clinical judgment.     

血管瘤发病机制的研究进展

血管瘤是婴幼儿常见的良性肿瘤，发病率高，危害性大。随着分子生物学的发展，学者们从细胞、细胞因子、基因、蛋白酶及其抑制剂、雌激素方面对血管瘤的发病机制进行了大量的探索。本文就该领域的研究进展作一综述。