高分辨率超声及弹性成像在评价普萘洛尔治疗婴幼儿特殊部位血管瘤疗效中的价值

【摘要】目的：探讨高分辨率超声及弹性成像在评价普萘洛尔治疗婴幼儿特殊部位血管瘤疗效中的临床应用价值。方法：50例婴幼儿特殊部位血管瘤患儿口服普萘洛尔进行治疗,分别于治疗前、治疗后1个月、3个月和6个月进行超声检查,采用相关指标监测瘤体的动态变化,监测项目包括二维灰阶超声测量血管瘤纵径、横径及深度;彩色多普勒测量血管瘤内较大血管以及周围正常血管（颈总动脉）的直径及收缩期动脉峰值血流速度（PASV）、阻力指数（RI）;弹性成像分析血管瘤瘤体的弹性分级及应变率比值。采用配对t检验进行治疗前、后相关指标的比较。结果：50例患儿中,37例治愈,12例明显好转,1例复发。治疗后瘤体纵径、横径、深度及体积分别较治疗前缩小58%、60%、69%及93%;治疗后瘤体血管直径、PASV及RI较治疗前分别减小64%、74%和增高43%;治疗中瘤体弹性应变率较治疗前减小35%,治疗前与治疗后瘤体弹性分级及应变率差异无统计学意义（P＞0.05）。结论：普萘洛尔治疗婴幼儿特殊部位血管瘤有效,而对周围正常血管无明显影响,高分辨率超声及弹性成像技术作为无创性检查可以较好地对普萘洛尔治疗血管瘤的效果进行随访评估,值得临床推广应用。     

儿童肝脏血管瘤的介入治疗方法及疗效的初步探讨

目的探索儿童肝脏血管瘤的介入治疗方法及疗效。 方法回顾性分析我院31例实施肝脏血管瘤介入治疗患者的临床资料。年龄6 d至9岁；先天型肝脏血管瘤26例，婴儿型肝脏血管瘤5例；肝脏多发病变5例，单发病变26例。所有患者均接受CT平扫、CT增强扫描以及肝脏血管瘤硬化栓塞术。依据患者治疗前后CT影像学表现，分析肝脏血管瘤硬化栓塞术对不同分型患者治疗疗效。采用配对样本t检验分别比较婴儿型及先天型肝血管瘤介入治疗术前、术后体积差异。 结果23例接受单次介入治疗，6例接受2次介入治疗，2例接受3次介入治疗。26例患儿接受随访，包括先天型肝血管瘤23例，婴儿型肝血管瘤3例。11例瘤体完全消失，患儿完全康复，15例瘤体部分缩小（4例缩小70%以上，效果显著；6例缩小30%~50%，部分有效；5例缩小低于30%，效果欠佳）。先天型肝血管瘤术前、术后平均体积分别为（161.86 ± 21.40）cm³、（41.46 ± 9.73）cm³，婴儿型肝血管瘤术前、术后平均体积分别为（22.73 ± 1.92）cm³、（11.18 ± 3.18）cm³，术前、术后体积差异均具有统计学意义（P < 0.001）。 结论肝脏血管瘤硬化栓塞术是一种安全、有效的微创治疗方法，对儿童肝脏血管瘤治疗效果较好，且术前分型是儿童肝脏血管瘤介入治疗疗效的重要因素。     

介入栓塞联合普萘洛尔治疗婴幼儿弥漫型肝血管瘤7例北大核心CSCD

目的探讨介入栓塞联合普萘洛尔治疗弥漫型婴幼儿肝血管瘤(IHH)的安全性和有效性。方法回顾性分析7例弥漫型IHH患儿临床资料。采用介入栓塞联合口服普萘洛尔治疗方案。微导管超选择瘤体供血动脉,选用平阳霉素碘化油乳剂和聚乙烯醇(PVA)颗粒栓塞病灶,根据有无动静脉分流选择不同注射顺序,40%~50%病灶栓塞后停止栓塞,经肝固有动脉灌注平阳霉素稀释液。随访观察疗效、不良反应及并发症。结果7例弥漫型IHH患儿超选择性肝动脉栓塞术均获成功。术后口服普萘洛尔,逐渐增加剂量至2 mg/kg(2次/d)。术后随访5~14个月,4例完全缓解,2例部分缓解,总有效率为85.7%(6/7),1例死亡。未发生与介入栓塞及普萘洛尔相关并发症。结论介入栓塞联合口服普萘洛尔治疗弥漫型IHH安全有效。弥漫型IHH病情进展较快,建议在出现严重临床症状前尽早治疗。     

普萘洛尔联合重组人血管内皮抑制素治疗婴幼儿颜面部血管瘤临床分析

目的探讨普萘洛尔联合重组人血管内皮抑制素治疗婴幼儿颜面部血管瘤的疗效。方法采用小剂量口服普萘洛尔联合静滴重组人血管内皮抑制素治疗婴幼儿颜面部血管瘤。结果其中11例随访6个月~2年,5例血管瘤明显缩小,6例血管瘤消失,有效率100%。结论利用普萘洛尔联合重组人血管内皮抑制素治疗婴幼儿颜面部血管瘤具有无创伤、操作简便、安全可靠、治疗较彻底等优点。特别适用于经手术、硬化等治疗可能残留明显疤痕,影响外观的颜面部血管瘤。     

射频消融联合肝动脉栓塞治疗巨大肝血管瘤的效果评价

目的探讨射频消融（RFA）联合肝动脉栓塞（TAE）治疗巨大肝血管瘤（直径≥10 cm）的可行性、安全性及有效性。 方法收集我院2007年10月—2015年5月期间,经TAE序贯RFA治疗15例患者15个巨大肝血管瘤的临床资料。回顾性分析其一般资料、RFA治疗策略、消融相关并发症、完全消融率、消融灶直径变化及复发情况等。 结果所有患者均成功完成RFA联合TAE治疗。TAE后血管瘤的平均直径从（13.0±2.2）cm缩小至（7.1±2.0）cm。RFA治疗后,14个血管瘤（93.3%）获得完全消融。RFA治疗后1个月,消融灶平均直径缩小至（6.1±2.0）cm;6个月后缩小至（4.9±1.6）cm。15例患者中,4例患者发生了6个消融相关并发症;根据Dindo–Clavien分级,均属轻微并发症（I级）。 结论RFA联合TAE治疗巨大肝血管瘤是安全、有效的;TAE可有效阻断血管瘤血供,使瘤体缩小,降低后续RFA治疗的难度,减少消融相关并发症。     

口服普萘洛尔对婴幼儿血管瘤相关生长因子及凋亡因子表达水平的影响

目的观察口服普萘洛尔对婴幼儿血管瘤病灶内相关生长因子及凋亡因子表达水平的影响。方法选择2010年5月-2011年12月收治的年龄≤3个月、血管瘤病灶位于肢体或隐蔽部位、家属要求手术治疗但具备单独口服普萘洛尔治疗条件、排除用药禁忌证、先前未接受过任何治疗的病例作为研究对象,共39例。所有患者均在局麻下夹取血管瘤体组织活检,然后口服普萘洛尔(每次1mg/kg,每12h服药一次)8周,继而手术切除瘤体。通过HE染色观察用药前后组织结构及细胞形态的变化,采用免疫组化、实时荧光定量RT-PCR检测用药前后病灶组织内ADRB1、ADRB2、ERK、Akt、NF-κB、VEGFA、Cyclin D1、Cyclin E1、Ki-67、Bax、Bcl-2、caspase-8、Fas、Fas L、caspase-9、caspase-3表达水平的变化,并分别用CD34、Ki-67免疫组化染色及TUNEL染色检测用药前后病灶内新生血管密度(MVD)、细胞增殖情况(Ki-67阳性率)以及细胞凋亡指数。结果与用药前比较,口服普萘洛尔后血管瘤病灶内ADRB1、ADRB2、ERK、Akt、NF-κB、VEGFA、Cyclin D1、Cyclin E1、Ki-67、Bcl-2表达水平明显下降(P<0.01),Bax、caspase-3、caspase-9表达水平明显增高(P<0.01),Fas、Fas L、caspase-8表达水平无明显改变(P>0.05)。与用药前比较,用药后病灶内MVD、Ki-67阳性率明显下降(P<0.01),凋亡指数明显增高(P<0.01)。结论普萘洛尔可通过调节MAPKs和PI3K-Akt通路抑制血管瘤增殖,促进内源性凋亡,但对外源性凋亡途径无明显影响。     

介入治疗肝血管瘤的临床研究

目的：探讨平阳霉素碘油乳剂超选择栓塞治疗肝血管瘤的临床疗效和治疗体会。方法：对23例肝血管瘤患者,采用平阳霉索碘油乳剂超选择性动脉插管行栓塞治疗,观察治疗前和治疗后6个月、12个月时患者临床症状、肿瘤大小的变化以及出现的并发症。结果：所有患者在术后6个月和12个月复查CT,见瘤体血供消失,其内碘油沉积良好,并出现瘤体缩小、碘化油聚积征象。术前血管瘤直径为（8．1±2．2）cm,术后6个月血管瘤直径为（5．4±1．3）cm,术后12个月血管瘤直径为（3．4±1．2）cm。治疗前有临床症状者治疗后缓解或消失。术后均未出现胆囊坏死、胆管狭窄和肝坏死等严重并发症发生。结论：超选择性肝动脉插管平阳霉素碘油乳剂栓塞治疗巨大肝血管瘤是一种疗效肯定、相对安全较为理想的治疗方法。     

婴幼儿血管瘤基于β-受体阻滞剂的综合序贯治疗临床研究

目的探讨综合应用以β-受体阻滞剂为基础治疗儿童血管瘤的临床疗效，并讨论其序贯治疗方案。 方法通过回顾性分析2013年5月至2018年5月间在我科完成使用β-受体阻剂或联合其他治疗方案、并随访满6个月的血管瘤患儿的临床资料，共1 691例，其中男541例，女1 150例，浅表型213例，深部型328例，混合型1 150例。根据治疗原则6个月前浅表型的使用噻吗洛尔滴眼液外敷，6个月后还有红斑则辅助激光治疗；深部型及混合型的口服普萘洛尔片，瘤体直径超过5 cm的深部型或混合型血管瘤则联合经导管动脉硬化栓塞治疗，动态地观察和记录血管瘤相应的大小、质地以及颜色变化，观察并随时处理治疗过程中出现的不良反应。随访6～24个月，平均13个月，按4级评分法对近期疗效进行评价。 结果1 691例患儿中，远期疗效评定为Ⅳ级（优）者1 051例（62.2％），Ⅲ级（好）392例（23.2％），Ⅱ级（中）211例（12.5％），Ⅰ级（差）37例（2.1％)，其中总的有效率为85.3％。不良反应：溃疡和疤痕16例（0.9％），残留脂肪结缔组织11例（0.6％），表皮萎缩8例（0.4％）。 结论基于β-受体阻滞剂的综合序贯治疗对婴幼儿血管瘤是一种安全、有效的治疗方法，副作用低，值得临床广泛推广。     

平阳霉素在介入治疗舌、颌面部血管瘤中的临床初步应用

目的:评价平阳霉素介入治疗舌、颌面部血管瘤的应用价值.材料和方法:利用介入方法经导管灌注平阳霉素与明胶海绵颗粒治疗舌、颌面部血管瘤13例(颌面部血管瘤12例,舌血管瘤1例).结果:治疗后7例病变缩小超过90%,4例病变缩小50%～75%,2例得到根治.均无严重并发症.结论:平阳霉素、明胶海绵混合治疗舌、颌面部血管瘤,具有很好的治疗效果.     

MEBO预防核素治疗后放射性皮肤损伤的临床体会

目的 观察湿润烧伤膏（MEBO）预防放射性核素32P敷贴治疗皮肤血管瘤后出现的放射性损伤的临床效果.方法 将100例患儿随机分为两组,治疗组（ MEBO组）50例和对照组（龙胆紫组）50例分别采取换药治疗,比较MEBO处理放射性皮肤损伤和1％龙胆紫外涂处理放射性皮肤损伤的疗效.结论 使用湿润烧伤膏能有效地预防和减少放射性损伤的发生,放射性核素32P敷贴治疗血管瘤的效果较常规处理明显提高了血管瘤的治愈率.     

Transcatheter Arterial Sclerosing Embolization for the Treatment of Giant Propranolol-Resistant Infantile Hemangiomas in the Parotid Region

PurposeTo report the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of parotid infantile hemangiomas that did not respond appreciably to propranolol.Materials and MethodsA total of 21 infants (12 male and 9 female) with large propranolol-resistant infantile hemangiomas in the parotid region were enrolled in this study. During TASE, the feeding arteries of the lesions were embolized using pingyangmycin-lipiodol emulsion and polyvinyl alcohol particles (300–500 μm) to reduce the blood flow rate. All children were followed up as outpatients at 2 weeks and monthly thereafter. The curative effect was evaluated at the 1- and 3-month follow-up visits.ResultsNine lesions were located on the right side of the parotid gland, whereas 12 were located on the left side. The feeding arteries in all patients originated from branches of the external carotid artery. TASE was technically successful in all patients. The mean (± SD) maximal diameter of the hemangiomas significantly decreased from 6.50 cm ± 2.28 before treatment to 3.56 cm ± 1.84 at 1 month after TASE (P <. 05). Three months after TASE, the mean maximal diameter further significantly decreased to 1.94 cm ± 1.58 (P <. 05). During the follow-up period, 16 cases were rated as excellent and 5 as good; no recurrence or serious complications were noted. Minor side effects, such as slight pain, mild fever, and tissue swelling, were observed.ConclusionsTASE significantly decreased the size of the parotid hemangiomas with minor side effects during a short follow-up period.     

平阳霉素治疗颌面部血管瘤的远期疗效观察

目的　探讨平阳霉素治疗血管瘤的疗效和并发症。方法　总结采用平阳霉素瘤腔局部注射颌面部头颈部血管瘤满 5年的 4 32例病例情况。结果　海绵状血管瘤、莓样血管瘤、混合性血管瘤治愈显效率达 77 95 %、90 78%、80 5 6 % ,有部分病例合并有疤痕、色素异常、皮肤皱缩、组织畸形并发症。结论　平阳霉素治疗颌面部血管瘤疗效可靠 ,应注意防止并发症的产生。     

激光联合药物血管内介入治疗婴幼儿血管瘤

目的总结激光联合疗法治疗婴幼儿血管瘤的临床疗效,探讨最佳联合治疗方案。方法各类型婴幼儿血管瘤363例,其中浅表毛细血管瘤303例,采用连续Nd:YAG激光或脉冲染料激光联合平阳霉素局部注射治疗;深部血管瘤54例,采用脉冲染料激光联合介入治疗;婴幼儿重症血管瘤6例,采用脉冲染料激光联合口服激素治疗和平阳霉素局部注射治疗。随访2～5年评定治疗结果。结果 363例患儿治疗效果:治愈率47.9%,显效率33.6%,有效率18.5%。并发症发生率:凹陷性瘢痕3.6%,表皮纤维化8.0%,色素沉着3.3%,色素减退1.4%。结论激光联合疗法治疗婴幼儿血管瘤,可达到恢复外观和功能的最佳疗效,并可缩短治疗周期,减少并发症。     

Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy

Early and long-term results of treatment with local low-dose thrombolysis in 554 patients with 564 peripheral arterial occlusions are reported. Of 92 embolic occlusions present for 2 months or more, 59 (64.1%) were recanalized with a cumulative patency of 89.5% after 5 years. Of 472 thrombotic occlusions present for up to 6 months and more, 254 (53.8%) were successfully treated with a cumulative patency of 58.8% after 5 years. The hospital mortality and amputation rate were 1.6% and 1.95%, respectively. The average age of the patients was 69.1 years and more than half of those treated had stage III or IV disease. A 6-year experience with local low-dose thrombolytic therapy has completely confirmed its efficacy and has led to improvements in technique, which are described. The doses of streptokinase and urokinase needed for a successful result have been substantially reduced and the duration of treatment shortened. The number of complications has also been reduced. Differential therapeutic considerations compared to vascular surgery are mentioned. The results should motivate a reconsideration of the diagnostic and therapeutic measures to be used in the treatment of peripheral arterial occlusions.     

Intracranial infantile hemangiomas associated with PHACE syndrome

BACKGROUND AND PURPOSE: Head and neck infantile hemangiomas are common lesions that are rarely observed in an intracranial location. We report 4 patients with orbital infantile hemangiomas and ipsilateral enhancing intracranial lesions, presumed to be infantile hemangiomas. METHODS: Imaging studies and medical records of 4 infants with orbital hemangiomas and enhancing intracranial lesions were reviewed. The intracranial lesions were evaluated in terms of their location, signal intensity characteristics, enhancement pattern, and degree of involution following treatment. Additional findings associated with PHACE syndrome were also noted and a literature review of intracranial infantile hemangiomas and PHACE syndrome was also performed. RESULTS: The intracranial masses were primarily in or adjacent to the internal auditory canal and demonstrated imaging characteristics and treatment response similar to the ipsilateral orbital lesions. Ipsilateral internal carotid artery hypoplasia, ipsilateral cerebellar hemisphere hypoplasia, and/or other head and neck hemangiomas were present in all patients. CONCLUSION: These cases collectively support the diagnosis of intracranial infantile hemangiomas and suggest a unique radiographic association between PHACE syndrome and intracranial infantile hemangiomas.     

Radiation therapy for life- or function-threatening infant hemangioma

PURPOSE: To assess the effectiveness and long-term results of radiation therapy in infants with life- or function-threatening hemangiomas. MATERIALS AND METHODS: Thirteen patients with life- or function-threatening hemangiomas (eight male, five female; age range, 0-8 months; median age, 2 months) were treated with radiation therapy. Life-threatening hemangiomas were treated with five fractions of radiation per week, and function-threatening hemangiomas were treated with two fractions per week. A median dose of 10 Gy was delivered to each hemangioma. The presence of residual hemangiomas, skin changes, functional problems, and growth delay was evaluated. RESULTS: All patients with Kasabach-Merritt syndrome (KMS) showed regression of the hemangioma and an increase in platelet counts to greater than 100,000 per cubic millimeter (1.0 x 10(11) per liter) within 40 days after radiation therapy. The treatment field was inadequate in two patients who required reirradiation or a change of treatment portal. With the exception of the patients with KMS, all but one patient experienced relief from symptoms in 40 days. Severe long-term radiation-related morbidity was noted in one patient who required reirradiation for a relapsed hemangioma. CONCLUSION: Radiation therapy (in doses of < or = 10 Gy in 2-Gy fractions) is indicated for life-threatening hemangiomas and for some function-threatening hemangiomas.     

脊椎血管瘤综合治疗疗效评价

目的　评价放射治疗和综合治疗在椎体血管瘤治疗中的地位和作用。方法　回顾性分析 2 2例有症状椎体血管瘤临床症状、影像学表现、治疗方法以及治疗后随访情况。结果　本组 2 2例单纯放疗 10例 ,综合治疗 12例 ,治疗后 19例症状完全缓解 ,3例部分缓解 ,无明显并发症及恶性变 ,无治疗后复发。结论　对脊椎血管瘤采用术前介入法栓塞供血动脉并椎体减压术结合术后放疗的综合治疗方法具有快速缓解压迫、减少术中出血、疗效确切的优势。     

伊曲康唑联合甲床修整术治疗重症甲真菌病的疗效观察

目的观察口服伊曲康唑联合甲床修整术治疗重症甲真菌病的临床疗效。方法将140例甲真菌病患者随机分为两组,治疗组68例采用甲床修整术联合口服伊曲康唑治疗;对照组72例单纯口服伊曲康唑治疗。结果治疗组痊愈率及总有效率分别为70.6%及88.2%,对照组分别为45.8%及65.2%,两组患者痊愈率及总有效率差异均有显著统计学意义(P<0.01)。结论伊曲康唑口服联合甲床修整术治疗重症甲真菌病疗效高,能显著改善新甲的生长速度及外观。     

不同气压下氧疗法联合治疗重型颅脑损伤137例

目的 探讨不同气压下氧疗法联合应用对有合并症的重型颅脑损伤患者的治疗效果。方法 197例有合并症的重型颅脑损伤患者分为联合氧疗法组（A组）137例和常规高压氧（HBO）治疗组（B组）60例，分别采用早期常压下面罩或吸氧头罩吸纯氧＋HBO联合疗法和常规HBO疗法两种方案治疗，比较两组的疗效，观察患者对治疗的反应和适应性。结果 A组治疗效果、治愈率明显优于B组（P〈0．01），开始治疗的时间也明显早于B组，而越早治疗治愈率越高。治疗后两组血氧饱和度均明显提高，心律失常好转，差异无显著性（P〉0．05）；HBO治疗时心率、血压、呼吸的变化与常压氧治疗比较差异有显著性（P〈0．01）。结论 对有合并症的重型颅脑损伤患者早期采用不同气压下氧疗法联合治疗，是既有效又安全的治疗方案，可明显提高治愈率和生存质量。