葡萄酒色斑增生机制的研究

目的:葡萄酒色斑被认为是一种稳定的先天性毛细血管畸形,但在后期却往往出现病灶的结节状增大与病灶增厚等增生表现,而在临床上常被称为"混合型血管瘤",这一现象的机制值得探讨.方法:通过对31例葡萄酒色斑标本的研究,比较了普通型葡萄酒色斑与增生结节中血管平均管腔直径、管壁内皮细胞密度及内皮细胞的形态,并检测了标本中与细胞增殖相关的抗原(如增殖细胞核抗原PCNA、血管形成因子VEGF、bFGF).结果:增生结节中畸形血管明显扩张,无细胞增殖的依据.结论:发现大部分葡萄酒色班增生的直接原因是畸形血管的显著扩张所致,不是因为类似血管瘤的细胞增殖.该结论对其命名、治疗原则等均提供了理论依据.同时,在其中一个病例中发现了内皮细胞增殖及血管新生的现象,提示血管瘤与血管畸形的相互关系需要进一步的研究.     

葡萄酒色斑增生机制的研究

目的 :葡萄酒色斑被认为是一种稳定的先天性毛细血管畸形 ,但在后期却往往出现病灶的结节状增大与病灶增厚等增生表现 ,而在临床上常被称为“混合型血管瘤” ,这一现象的机制值得探讨。方法 :通过对 31例葡萄酒色斑标本的研究 ,比较了普通型葡萄酒色斑与增生结节中血管平均管腔直径、管壁内皮细胞密度及内皮细胞的形态 ,并检测了标本中与细胞增殖相关的抗原 (如增殖细胞核抗原PCNA、血管形成因子VEGF、bFGF)。结果 :增生结节中畸形血管明显扩张 ,无细胞增殖的依据。结论 :发现大部分葡萄酒色班增生的直接原因是畸形血管的显著扩张所致 ,不是因为类似血管瘤的细胞增殖。该结论对其命名、治疗原则等均提供了理论依据。同时 ,在其中一个病例中发现了内皮细胞增殖及血管新生的现象 ,提示血管瘤与血管畸形的相互关系需要进一步的研究     

葡萄酒色斑增厚及结节形成的病理基础和临床意义

目的 通过分析葡萄酒色斑增厚和结节病灶的组织学特点,探讨其可能的扩张机制.方法 观察3例葡萄酒色斑平坦病灶、11例增厚病灶、9例结节病灶的HE切片,分析比较不同病灶的组织学特征.结果 普通葡萄酒色斑主要表现为真皮浅层轻度血管的扩张,不伴其他皮肤组织的增生.葡萄酒色斑增厚病灶主要表现为真皮层血管进一步扩张,伴皮脂腺增多、毛囊肥大、皮脂腺分泌物淤积等错构现象.葡萄酒色斑结节可分为3种不同表现类型:Ⅰ类似葡萄酒色斑增厚病灶,表现为真皮层血管扩张,伴皮脂腺增多、毛囊肥大、皮脂腺分泌物淤积的错构现象;Ⅱ类表现为真皮层大量扩张血管,呈蜂窝状,问质少,但未观察到其他组织的错构现象;Ⅲ类表现为扩张血管少,组织弥漫胶原化,间质疏松,淋巴细胞灶性浸润,呈淋巴水肿样改变.结论 葡萄酒色斑增厚病灶、增牛结节组织中,部分病灶完伞以扩张血管为主要构成成分,另一部分则不仅观察到不同程度的扩张血管,同时表现出外分泌腺增多、毛囊肥大,并且葡萄酒色斑结节可分成3种不同的表现类型.提示畸形血管的进行性扩张是葡萄酒色斑增生的重要基础,但在部分病例中,增厚与结节可能源于不明原因的组织增生.     

葡萄酒色斑增生体制的研究

目的：葡萄酒色斑被认为是一种稳定的先天性毛细血管畸形，但在后期地往往出现病灶的结节状增大与病灶增厚等增生表现，而在临床上常被称为“混合型血管瘤”，这一现象的机制值得探讨。     

肥厚型葡萄酒色斑的影像学和病理学特点分析

目的分析肥厚型葡萄酒色斑(Port-wine stains,PWS)的影像学和病理学特点,以期为改善该病的治疗效果提供依据。方法对32例接受过激光治疗的肥厚型PWS患者的面部MRI资料进行分析,对其增厚程度和血管畸形程度进行评价分级;对其中18例患者进行组织学检查,并与15例平坦型患者进行对比分析,探讨两种类型的血管组织学结构差异。结果 MRI资料的相关性分析证实,软组织厚度随畸形血管分布增多而增加(P<0.001)。组织学显示,肥厚型相较于平坦型PWS患者,其面部脂肪层和肌肉层的血管口径更大(0.048 mm vs 0.020 mm,P=0.004;0.035 mm vs 0.017 mm,P=0.008),并且管壁更厚(0.014 mm vs 0.006 mm,P=0.003;0.010 mm vs 0.006 mm,P=0.020)。结论肥厚型PWS患者激光疗效较差,与患者深部畸形血管明显超出现有激光对血管热凝固的破坏深度相关。     

葡萄酒色斑光动力学疗法的研究进展

上世纪90年代,我国首先开始将光动力学疗法(Photodynamic Therapy,PDT)用于葡萄酒色斑(Port Wine Stain,PWS)的治疗。PDT由两大重要因素构成:光敏剂、激发光源。光动力学疗法通过直接杀伤细胞,破坏病灶血管,引发细胞凋亡,免疫调节等来发挥作用。因其对靶组织具有高敏感性,可减少正常组织的损伤。目前,PDT主要用于皮肤外生性疾病和眼、鼻腔、口腔及呼吸道、消化道、泌尿生殖道等腔道内肿瘤的治疗。本文就PDT在治疗葡萄酒色斑上的应用及研究进展进行综述。     

葡萄酒色斑的Waner分型与治疗

目的探讨葡萄酒色斑(PWS)的Waner分型、治疗选择及临床疗效。方法137例PWS按Waner分型,其中Ⅰ~Ⅲ型129例,采用Vbeam染料激光治疗;Ⅳ型8例,采用病灶切除全厚皮片移植或扩张皮瓣移位术。结果Ⅰ、Ⅱ型PWS103例,治愈率24.27%(25/103),有效率51.45%(53/103);Ⅲ型PWS26例,治愈率3.84%(1/26),有效率11.53%(3/26)。并发症:水泡17例,浅表瘢痕7例,铁锈样色斑13例。Ⅳ型PWS8例,手术后外形明显改善。结论Vbeam染料激光对Ⅰ、Ⅱ型PWS疗效较好,Ⅲ型疗效较差;Ⅳ型手术是最佳的选择。     

Vbeam脉冲染料激光治疗皮肤葡萄酒色斑的疗效分析

目的 评价595 nm Vbeam脉冲染料激光治疗皮肤葡萄酒色斑(Pint wine stains,PWS)的临床疗效.方法 共114例PWS患者接受595 nm Vbeam脉冲染料激光治疗,脉宽3～10 ms,光斑直径7mm,能量密度10-15 J/cm2,动态冷却喷射30～40 ms,间隔10～30 ms,治疗间隔4～8周.根据皮损消退,将疗效分为4级:Ⅰ级为＞75%,Ⅱ级为50%～74%,Ⅲ级为25%～49%,Ⅳ级为＜25%.结果 114例经过1～10次治疗(平均5.9次),取得很好临床效果,其中Ⅰ级74例(64.9%),Ⅱ级29例(25.4%),Ⅲ级9例(7.9%),Ⅳ级2例(1.8%).并分析治疗次数、年龄大小、发生部位、颜色特点和疗效的关系,年龄小、发生于颈面部位、粉红型病损者疗效显著.随访6个月至2年,无复发,治疗部位无瘢痕形成.结论 595 nm波长Vbeam脉冲染料激光治疗皮肤PWS效果良好,并发症少,是目前一种很安全、较可靠的治疗方法.     

葡萄酒色斑的Waner分型与治疗

目的探讨葡萄酒色斑（PWS）的Waner分型、治疗选择及临床疗效。方法137例PWS按wane，分型，其中Ⅰ～Ⅲ型129例，采用Vbeam染料激光治疗；Ⅳ型8例，采用病灶切除全厚皮片移植或扩张皮瓣移位术。结果Ⅰ、Ⅱ型PWS103例，治愈率24．27％（25／103），有效率51．45％（53／103）；Ⅲ型PWS26例，治愈率3．84％（1／26），有效率11．53％（3／26）。并发症：水泡17例，浅表瘢痕7例，铁锈样色斑13例。Ⅳ型PWS8例，手术后外形明显改善。结论Vbeam染料激光对Ⅰ、Ⅱ型PWS疗效较好，Ⅲ型疗效较差；Ⅳ型手术是最佳的选择。     

Histology of port-wine stain

Summary Our present histological knowledge of the port-wine stain is limited because of the small size of biopsies taken in the past. During the last two decades, Clodius has performed subtotal excision of port-wine stains, and has covered the defects with full thickness skin grafts. The availability of large surgical specimens of dermis affected by port-wine stain prompted the present study. Specimens from 50 locations were obtained in 28 patients. The pathomechanism of the port-wine stain was found to be telangiectasia of normal capillaries, sometimes congenital abnormal increase of the number of cutaneous vessels, or both. The theory of gradual age-dependent transformation of port-wine stain is true in regard to the colour of the affected skin, but is not valid in regard to the parallel increase of the vessel lumina and RBC filling grade. One-third of the patients below the age of 30 had the wide type lesion. The extreme histological differences in the size of the abnormal vessels, and the percentage of vascular area filled with RBC's were repeatedly noted in the different regions of the face in the same patient. Furthermore, even within the same area, the histology of port-wine stain varies greatly. The value of the small biopsies presently used for the assessment of laser treatment for these lesions is questioned.Presented in part at the Meeting of Swedish Society of Plastic Surgery, Stockholm, December 1, 1988     

Investigating the structure of the port-wine stain by transcutaneous microscopy

The structures present in port-wine stains of patients presenting for argon laser therapy were examined by means of a simple transcutaneous microscope. This method is non-invasive and allows the investigator to make a thorough examination of the naevus. The port-wine stain was found to contain a variety of aberrant capillary and vascular structures. Abnormalities of the capillaries of the dermal papillae result in a variety of structures ranging from simple increase in the size of the capillaries to elongation of the vessels and breakdown of the tone of the vessel walls to give structures which resemble cavernous haemangiomata. Abnormalities of the vessels deeper down in the subdermal vascular plexus may also be seen. Occasionally, tufts of several capillaries may originate from a small feeder vessel. The capillaries in some lesions may be abnormally elongated, complex, helically twisted and very thin. Naevi on the face appear different from those on the limbs although this has not yet been verified by extensive observation.     

Assessing argon laser therapy of port-wine stains

The outcome of argon laser therapy of port-wine stains (PWS), treated over an 8-year period, has been investigated. Of 571 patients that have attended a clinic between 1984 and 1992, a definite outcome of treatment has been derived for 417 patients. Outcome was assessed clinically in terms of lightening of colour and quality of skin surface after therapy. Transcutaneous microscopy (TCM) was also used to provide an initial classification of the nature of the PWS abnormality and to assist in the assessment of the outcome. Good to excellent results were achieved in 44% of the older patients, aged above 18 years. This result was achieved in 23% of children, aged 18 years and below. The outcome of treatment may related to the classification of the lesion. The majority of the lesions in children were classified as the types containing relatively normal blood vessels, whereas many of the older patients had lesion types containing dilated ectatic vessels.     

光动力疗法治疗鲜红斑痣的疗效

目的探讨光动力疗法（photodynamic therapy,PDT）治疗鲜红斑痣的临床疗效和安全性。方法采用PDT治疗鲜红斑痣125例。根据患者体重,静脉推注相应的光敏剂PSD-007后,皮损局部行铜蒸气激光照射,至红斑肿胀渗出为治疗结点;每次治疗前采集红斑图像以评价治疗效果。2个月后复诊,采用5级分类法评价前次治疗的效果,并进行患者满意度调查,根据红斑减退变平等情况决定治疗结束或继续下一个疗程治疗。结果PDT治疗鲜红斑痣临床效果明显,治疗后即可出现明显的畸形血管肿胀封闭,经过4个疗程的治疗,治愈率达49．60％,显效率达96．00％,其中经过不到2个疗程的治疗,治愈率即达到13．60％。在整个治疗过程中,患者满意率为95．20％。结论PDT治疗鲜红斑痣疗效显著,美容效果好,不良反应小,值得临床推广应用。     

Angiogenesis and proliferation of endothelial cells in hypertrophic and nodular port-wine stain

BackgroundPort-wine stain (PWS) has been classified not as the hyperplasia of cells, but rather, as an expansion of malformed vessels. However, previous studies have reported upregulated expression of proangiogenic factors in PWS. Several studies have indicated that the pathology exhibits proliferation of numerous endothelial cells in hypertrophic/nodular PWS. This study aimed to determine the expression of vascular epithelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), angiopoietin-2 (ANG-2), and basic fibroblast growth factor (bFGF) in hypertrophic PWS.MethodsImmunohistochemistry was used to analyze skin samples from 33 patients with hypertrophic PWS. Expression levels of VEGF, MMP-9, ANG-2, and bFGF in hypertrophic PWS were determined by multiplying the intensity by the percentage of immunoreactive cells. Immunoreactivity scores were classified as follows: negative (0), low (1), moderate (2, 3, and 4), or high (6).ResultsBased on pathological characteristics, hypertrophic PWS was divided into vascular malformation and pyogenic granuloma (PG) types. VEGF, MMP-9, ANG-2, and bFGF were significantly activated in the blood vessels of PG-type PWS samples compared with their counterparts in blood vessels of vascular malformation-type PWS samples and controls. PG-type hypertrophic PWS, which exhibited proliferation of endothelial cells, showed the strongest activation.ConclusionThe exuberant proliferation of endothelial cells in PG-type hypertrophic PWS may be associated with the regulation of proangiogenic factors during development. These proangiogenic factors that function in the angiogenesis and proliferation of endothelial cells may play an important role in the pathogenesis and progression of PWS. Furthermore, these factors may be dynamic and behave differently in various types of hypertrophic PWS.     

Pyogenic granulomas,port-wine stains and laser therapy

Three cases of pyogenic granulomas arising as a complication of laser therapy for vascular lesions (two port-wine stains, one cherry angioma) are presented. The possible aetiological factors contributing to this complication are discussed. In a study of the case notes of 141 patients with port-wine stains, the interrelationships of port-wine stains, pyogenic granulomas arising de novo, and nodularity within a port-wine stain are reviewed.     

Dye laser treatment of port-wine stains

The author treated 456 cases of port-wine stains using a tunable dye laser (577-nm wavelength, 1-s pulse, 2–3-mm diameter spot), and followed up 22 cases for a year or more after the initial treatment. The treatment was regarded as effective in 80.5% of the abnormal lesions. The results were anfluenced by location; good results were achieved in the neck region and face, but results in the extremities were poor. The dye laser can achieve selective injury to abnormal vessels of port-wine stains while inflicting less damage to the overlying dermis than the argon laser. Therefore, dye laser treatment for port-wine stains is more effective than argon laser treatment.     

Surgery for the extensive facial port-wine stain?

In contrast to true hemangiomas, which are vascular neoplasms, port-wine stains (PWS) are vascular malformations. They consist of mature teleangiectatic vessels in the dermis and the adjacent subcutis. The series of 50 patients here reported have been treated by subtotal excision of their PWS, covering the resulting defects with carefully selected full-thickness skin grafts.     

Application of short-pulsed CO2 laser and long-pulsed Nd:YAG laser in the treatment of severe hypertrophic port-wine stains

BackgroundThe treatment of port-wine stains (PWS) becomes extremely difficult due to age-related malformation of the vasculature. In this study, we used alternative methods to treat hypertrophic PWS.MethodsA short-pulsed CO₂ laser was applied to ablate the hypertrophic vasculature of PWS. The ablation was ended when the wound was on the same plane as normal skin. The long-pulsed neodymium-doped yttrium-aluminum-garnet (lpNd:YAG) laser was primarily applied to coagulate and subsequently liquefy the hypertrophic vasculature of the PWS. The therapeutic energy used in treating different lesions should be carefully regulated to significantly affect the treatment outcomes.ResultsThe two cases presented herein demonstrated substantial improvement in hypertrophic vasculature that was largely removed. The skin was resurfaced, although some scar formation and mild hypopigmentation occurred.ConclusionWe suggest the use of short-pulsed CO₂ and lpNd:YAG lasers for treating certain cases of hypertrophic PWS. When using a short-pulsed CO₂ laser, it is wise to judge the treatment endpoint and take appropriate precautions to avoid intraoperative bleeding. When using an lpNd:YAG laser, the therapeutic energy should be controlled according to the thickness of the lesion to reduce scar formation.