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。     

淋巴管畸形的硬化治疗

淋巴管畸形是一种常见的脉管畸形.硬化治疗是一种常用的治疗方法,临床将其作为一线治疗均获得较满意的疗效且无明显并发症.目前应用的硬化剂种类繁多,但没有一种能适应于所有病变.由于病变类型不同及使用的硬化剂不同,回顾性研究的结果也不一致.较多的临床研究表明,大囊型淋巴管畸形硬化治疗的疗效优于微囊型,对于大囊型病变或以大囊成分...     

平阳霉素治疗脉管性疾病规范

采用平阳霉素治疗血管瘤和脉管畸形,已被证实具有良好的疗效,但对其不良作用,应引起高度重视,并采取相应预防措施。本指南确定了平阳霉素治疗脉管畸形的适应证、浓度、用药方法、不良作用和预防抢救措施,对临床治疗具有重要的指导作用。     

血管瘤与脉管畸形的鉴别诊断研究进展

血管瘤和脉管畸形是婴幼儿比较常见的血管疾病,过去由于对两者的分类和诊断比较混乱,给临床治疗带来诸多不便,也给患者增加了不必要的痛苦。1982年,Mulliken和Glowacki提出了脉管性疾病的生物学新分类,将血管瘤和脉管畸形归类为2种性质完全不同的病变。血管瘤是多发于婴幼儿的良性肿瘤,大多数可以自行消退;而脉管畸形是血管结构的发育异常,不会自行消退,随患者的生长发育持续增长。因此,对于确诊的脉管畸形,应尽早采取干预措施。这就要求临床医师能及时、准确、有效地鉴别诊断血管瘤和脉管畸形。本文就目前关于血管瘤和脉管畸形的鉴别诊断进展作一综述。     

90锶、90镱敷贴治疗颌面部血管瘤及脉管畸形疗效观察

目的　观察应用90 锶、90 镱敷贴器治疗婴幼儿颌面部血管瘤、脉管畸形的疗效。方法　采用多次小剂量90 锶、90 镱对 96例患儿颌面部血管瘤、脉管畸形进行敷贴治疗。结果　总有效率为 98.96 %。结论　90 锶、90 镱敷贴治疗婴幼儿颌面部血管瘤、脉管畸形操作简单、并发症少 ,疗效满意     

平阳霉素治疗血管瘤61例临床观察

平阳霉素治疗血管瘤６１例临床观察刘洪泉祁建春山东省乐陵市人民医院血管瘤和血管畸形的治疗，多年来主要以手术、硬化剂注射、激素、激光、冷冻等治疗方法。近年来我们应用平阳霉素治疗血管瘤临床应用６１例，效果满意，现报道如下：１临床资料本组病人均为颌面部血管瘤...     

合并呼吸道梗阻的血管瘤和脉管畸形32例治疗分析

目的：总结合并呼吸道梗阻的血管瘤和脉管畸形的临床特点和治疗经验。方法：1985年6月～2003年6月间．收治32例合并不同程度的呼吸道梗阻和呼吸困难的血管瘤和脉管畸形病例，男20例，女12例，年龄2个月～46岁。平均年龄9．31岁。其中血管瘤3例，静脉畸形12例，淋巴管畸形17例。病变原发于咽喉部4例，面颈部病变压迫或侵犯咽喉26例，上纵隔病变压迫气管2例。合并Ⅰ度、Ⅱ度、Ⅲ度呼吸困难分别为22例、7例、3例。采用口服糖皮质激素治疗3例．平阳霉素等硬化剂病变内注射治疗14例，手术治疗3例，手术 硬化剂病变内注射治疗12例。32例中，紧急气管切开4例，预防性气管切开11例。结果：3例血管瘤、16例淋巴管畸形和10例静脉畸形治愈；1例淋巴管畸形和2例静脉畸形好转；无效病例0例。结论：对合并呼吸道梗阻的血管瘤和压迫咽喉或气管的淋巴管畸形，分别采用激素疗法和单纯平阳霉素病变内注射治疗，治愈率高，一般不需气管切开；原发于咽喉部的局限性静脉畸形和淋巴管畸形手术容易治愈：侵犯咽喉部的静脉畸形和淋巴管畸形多合并面颈部广泛性病变，需采取手术 硬化剂注射 气管切开的综合治疗．方能治愈或控制病变发展。     

普萘洛尔在婴幼儿头颈部血管瘤中的应用

婴幼儿血管瘤（IH）是婴幼儿常见的良性肿瘤之一,60％发生于头颈部。IH具有自限性,但是仍有10％的婴幼儿需要治疗。目前临床上常用的治疗方法包括激素治疗、干扰素治疗、硬化治疗、激光治疗等,但均存在一定不足或不良反应。近来,普萘洛尔被证明对增生期血管瘤具有明显的消退作用。本文就普萘洛尔治疗血管瘤的分子机制、临床应用、不良反应等相关问题进行简要综述。     

泡沫硬化剂治疗脉管畸形的研究进展

脉管畸形是先天性发育异常，好发生于口腔颌面部，可能与调节正常血管树形成的传导通路异常有关。按照其组织学特点、临床特征及影像学表现又可分为微静脉、淋巴管、静脉、动静脉及混合畸形。由于脉管畸形临床表现及组织学构成具有复杂多样性，临床治疗效果不一，多数治疗方法有局限性。目前，对大面积、涉及多个解剖区的脉管畸形的治疗，尚缺乏简单、安全而有效的方法。病变内注射硬化剂是常用的治疗方法之一，可单独使用或结合手术综合治疗。     

与脉管畸形相关的综合征

皮肤脉管畸形是脉管发育障碍所导致的一类疾病．此类疾病虽然不常见，但易与婴幼儿血管瘤相混淆。由于脉管畸形和血管瘤的发病率、预后和治疗方法不同。因此对此病的诊断至关重要。脉管畸形可与隐匿性疾病或系统性疾病相关。该文列举与脉管畸形相关的系列综合征．并根据血流特点加以区别。该文使读者能够更好地认识与理解与脉管疾病相关的综合征，并熟悉对此类疾病的处理方法。     

Current concepts of vascular anomalies

The field of vascular anomalies is confusing because numerous types of lesions exist, different anomalies often look similar, and imprecise terminology commonly is used. Pharmacotherapy is effective for certain vascular tumors; sclerotherapy generally is the primary treatment of problematic lymphatic and venous malformations. Arteriovenous malformations remain difficult to manage because of their high progression and recurrence rates. Propranolol has gained popularity recently for the treatment of problematic infantile hemangioma, but its efficacy and safety compared with corticosteroid therapy have not been studied. Continuing education is needed to increase the use of accepted biologic terms to describe vascular anomalies; this will improve patient care and facilitate research. As vascular anomalies centers continue to develop, children will have easier access to interdisciplinary expertise. Patients are most likely to be diagnosed and treated properly when managed by a specialist or team focused on these conditions. Recent insight into the etiopathogenesis of infantile hemangioma and vascular malformations may lead to novel therapies for these lesions in the near future.     

Diagnosis and management of hemangiomas and vascular malformations of the head and neck

Oral Diseases (2010) 16 , 405–418 Vascular anomalies are congenital errors in vascular development. They frequently involve the head, neck, and oral cavity. Subdivided into vascular tumors (hemangiomas) and vascular malformations, vascular anomalies remain poorly understood. However, growing interest and recent advances in the diagnosis, management, and molecular characterization of these lesions are improving treatment strategies. The role of the multidisciplinary team cannot be overstated. This review provides both basic and up‐to‐date knowledge on the most common vascular anomalies encountered by physicians and practitioners. Because treatment options for vascular anomalies are widely variable and often debated, this report aims to provide a comprehensive approach to these lesions based upon current concepts and practical clinical experience.     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

43rd National AOMSI Conference

Vascular anomalies of the head and neck region are a complex group of lesions that challenge the head and neck physicians. From the very understanding of the difference between its two distinct forms, hemangiomas and vascular malformations to its management remain confusing. The review of this anomaly attempts at comprehensively understanding the disease. Vascular anomalies are easily diagnosed by their clinical presentation, but choice of imaging and management for this spectrum of lesions is varied. The author attempts to categorize the required imaging for the lesion with suggestions on the management of both hemangiomas and vascular malformations. The available treatment options are discussed, and a comprehensive algorithm for management is suggested. Further research in developing drugs that could restrict the growth of these lesions would be the future of the management of vascular lesions.     

Supraclavicular flap: reconstructive strategy for massive facial arteriovenous malformations

Arteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis. Hemodynamically, they are high-flow lesions. Approximately 50% of AVMs are located in the craniofacial region. The successful treatment of vascular anomalies depends on the profound knowledge of the biologic behavior of vascular lesions and their correct classification. Vascular malformations that persist lifelong require treatment in most cases, especially when clinical symptoms occur. On the basis of individual parameters such as the diameter, location, or growth behavior, different therapeutic options such as cryotherapy, corticosteroids, laser therapy, sclerotherapy, surgical intervention, and/or embolization can be performed successfully. Subtotal excision or proximal ligation of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolization (superselective) followed by complete resection 24 to 48 hours later. Reconstructive procedures in the head and neck region use a wide range of flaps for defect closure. The methods range from local, mostly fasciocutaneous flaps and skin grafts, to free microsurgical flaps. To ensure a satisfactory functional and aesthetic result, good texture and color of the flap are always essential. Moreover, the donor-site defect needs to be reduced, with no resulting functional or aesthetic impairment. The supraclavicular flap has been used successfully for difficult facial reconstruction cases, providing acceptable results without using microsurgical techniques. We treated 2 patients with facial AVM by this method. Both of the lesions were located within the cheek and lip. There were no procedure-related complications, and the cosmetic results were excellent.     

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淋巴管畸形是常见于头颈部的一种先天性发育畸形。临床上常用的治疗方法主要有手术切除、硬化治疗、激光治疗等,可根据病变类型和病变范围选择其中一种方法或几种方法联合应用。口腔黏膜的微囊型淋巴管畸形适用激光治疗、平阳霉素注射或几种方法联合治疗。累及口腔和面颈部的淋巴管畸形的治疗困难较多,弥漫性病变手术切除后易复发,并发症发生率高。病变内注射平阳霉素、溶血性链球菌制剂(OK-432)可用于淋巴管畸形的治疗,大囊型病变的疗效明显优于微囊型。围手术期硬化治疗可提高微囊型病变的治愈率。     

Current concepts in diagnosis and treatment of venous malformations

IntroductionVenous malformations are the most common type of vascular malformation, usually detected at birth or during puberty. By occurring during human growth or through localized trauma, pain, functional impairment and aesthetic disfigurement is often observed.Ultrasonography, Doppler flow Imaging, and Magnetic Resonance Imaging are the most informative techniques which reveal the extent of tissue involvement and differentiate between high and low flow anomalies. Therapeutic options for treatment of venous malformations are sclerotherapy with alcohol, ethoxysclerol and bleomycin, laser therapy (Nd:YAG), surgery and combined therapeutic modalities. The aim of percutaneous sclerotherapy is the successive reduction of the volume of the lesion by aseptic inflammation.Patients and methodsThis is a review of 51 patients with venous malformation treated by the Interdisciplinary Center for Vascular Anomalies at the University Hospital Tübingen, (Germany), from July, 2002 until January, 2007. The mean age of first consultation in our outpatient department was 26.4 years (median).12 patients were treated by sclerotherapy with highly concentrated alcohol, 9 by surgery, and 7 by laser therapy. In some cases we combined different treatments. 9 patients had only sclerotherapy, while 3 had a combination of pre-operative sclerotherapy and surgery.ResultsWe obtained positive results in patients treated with sclerotherapy and combined sclerotherapy and surgery.ConclusionSclerotherapy is safe (under fluoroscopic control), efficient, and can be repeated multiple times. Therefore, it should be considered as first-line treatment in venous malformations. A combination of a sclerotherapy with surgery is also useful in many cases.     

Interdisziplinäres Konzept zur Diagnostik und Therapie gefäßreicher Fehlbildungen im Gesichts- und Halsbereich

Purpose. In patients with extended vascular anomalies in the head and neck, therapeutic decisions may pose a challenge to maxillofacial surgeons, dermatologists, and interventional radiologists. We analyzed the value of an interdisciplinary classification and treatment concept. Patients and methods. The classification distinguishes hemangiomas and vascular malformations. Whereas hemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies, which are further classified into high-flow or low-flow lesions and according to the vascular channels into capillary, venous, or lymphatic malformations. Since 2000 we have provided interdisciplinary consultation for patients with vascular anomalies. In patients with hemangiomas and venous malformations, the clinical diagnosis is confirmed by color-coded duplex sonography and magnetic resonance imaging; angiography is performed as part of the treatment planning for patients with arteriovenous malformations. Patients with hemangiomas are treated surgically by cryosurgery or laser surgery or conservatively according to lesion size and behavior. In patients with venous malformations, percutaneous sclerotherapy is combined with surgical reduction; patients with arteriovenous malformations undergo transarterial embolization prior to surgical excision of the nidus. Results. A total of 73 patients attended the interdisciplinary consultation. This group included 53 patients with facial hemangiomas, 7 with venous malformations, 2 with capillary malformations, 5 with lymphatic malformations, and 6 with high-flow arteriovenous malformations. Conclusions. The interdisciplinary protocol increases diagnostic accuracy and helps to establish individual treatment plans for patients with extended vascular anomalies.