口腔颌面部血管瘤综合治疗疗效评价

目的:对血管瘤综合治疗的不同方法进行疗效评价。方法:对160例血管瘤患者进行统计,其中外科手术治疗60例,平阳霉素硬化治疗33例;鱼肝油酸钠硬化治疗27例,采用瘤周环扎和瘤内缝扎硬化治疗20例,冷冻治疗7例,激光治疗13例,结果:治疗后3~8年随访观察,单纯手术组治愈率为83.3%;非手术组中,平阳霉素硬化治疗、鱼肝油酸钠硬化治疗、瘤周环扎和瘤内缝扎硬化治疗、冷冻治疗、激光治疗治愈率分别为60.6%,44.4%,65.0%,28.6%,23.0%。手术治疗组与非手术治疗组间存在显著性差异(P<0.05)。结论:手术治疗是目前治疗口腔颌面部血管瘤理想、有效的主要方法,非手术治疗也可作为综合治疗血管瘤的辅助手段。     

端粒酶活性在血管瘤中表达的意义

目的：为探讨端粒酶活性表达与血管瘤病变发展中出现的生长自限性现象间的关系。方法：按年龄将因管瘤病人分成3组，I组为2岁以内的婴幼儿；Ⅱ组为年龄自3－18岁的病人；Ⅲ组为年龄超过18岁的病人。利用TRAP法测定每组病人肿瘤组织中的端粒酶活性，同时进行病理组织学观察。将测定的端粒酶活性表达情况与不同年龄组血管瘤病理学特点进行综合分析。结果：I组的端粒酶活性检出率高，其强阳性表达率也高；Ⅱ组端粒酶活性表达率较高，其强阳性表达率低；Ⅲ组的端粒酶活性的表达率低，无强阳性表达。I组的病理学特点为大量的致密的内皮细胞团，增殖活跃，管腔小而不明显；Ⅱ组增殖活跃的内皮细胞减少，可见较多的管腔；Ⅲ组增殖的内皮细胞少见，有明显管腔形成，可见纤维化及脂肪浸润。结论：端粒酶活性与血管瘤主要成分内皮细胞的增殖状态密切相关，影响内皮细胞的增殖能力，进而影响血管瘤的生长状态。     

Surgical treatment of hemangiomas and vascular malformations in functional areas

Hemangiomas and vascular malformations (VM) in functional areas can be treated by a variety of methods. Because of the natural involution of hemangiomas, a non-agressive approach is recommended. Active therapy is necessary only in cases where a function is affected such as vision, respiration, hearing, and feeding. Psychological problems can be an indication for early excision, and psychological/cosmetic reasons in the presence of fibrofatty tissue residues when the hemangioma has been involuted for late excision. In contrast to hemangiomas, no involution is to be expected for VMs, so that therapy depends mainly on the occurrence of functional problems and/or serious complications. Surgical excision still has a place, however, the indications are limited.     

Solitary hemangioma of the small intestine: an unusual cause of bleeding diagnosed at capsule endoscopy

Solitary small intestine hemangiomas are rare and usually present with overt bleeding or chronic anemia. Diagnosis is usually difficult because traditional imaging techniques often lack accuracy. Capsule endoscopy is a new diagnostic tool that has showed greater sensitivity than other methods to reveal causes of bleeding in the small intestine. A case of hemangioma of the ileum in a 13-year-old boy is presented. Capsule endoscopy allowed diagnosis and planning of surgical treatment.     

Posterior mediastinal hemangioma

We report posterior mediastinal hemangiomas in a 4-month-old and a 6-month-old girl. The masses were identified on radiographs of the chest followed by contrast-enhanced CT. Histological evaluation of the surgical specimens established the final diagnosis. Although mediastinal hemangiomas have been described, they remain a rare entity. A diagnosis can be suggested by relatively high attenuating masses on contrast-enhanced CT. Posterior mediastinal hemangiomas sometimes mimic neuroblastomas, which is the most common posterior mediastinal in this age group.     

Six cases of children with a benign cervical tumor who required tracheostomy

Cervical tumors sometimes cause airway obstruction. We have treated six children with benign cervical tumors who required tracheostomy. Two cervical and one glossal lymphangiomata treated with local injection of OK432 after creating a tracheostomy were successfully decannulated after the treatment. One patient with a giant cervical lymphangioma needed an EXIT (ex utero intrapartum treatment) procedure. He underwent tracheostomy at 10 months of age after long-term endotracheal intubation, but he died of sepsis and hypoxic brain damage at 18 months. One patient with a subglottic hemangioma treated with steroids finally achieved closure of the tracheostomy at 2 years of age. A 7-year-old girl with a tracheal schwannoma underwent tracheostomy performed a week after admission, but she already had hypoxic brain damage resulting from problems with intubation. Most patients with a lymphangioma or hemangioma in the cervical region have required early tracheostomy before commencing treatment with OK-432 or steroids. If there is any sign of possible airway compromise, then it is vital to perform an early tracheostomy, even for benign tumors.     

海绵窦海绵状血管瘤的诊断及治疗

目的总结海绵窦海绵状血管瘤的临床特点及其治疗方法。方法分析43例海绵窦海绵状血管瘤患者的病理学流行病学影像学特点,手术及术后并发症,并对43例患者进行以额颞入路,单纯额部入路及额颞联合耳前颞下入路的手术治疗。结果手术全切除22例,近全切除11例,部分切除10例。术后主要并发症为动眼神经麻痹16例,外展神经麻痹10例,面神经麻痹3例。无手术后死亡病例。结论目前,手术仍是海绵窦海绵状血管瘤比较有效的治疗方法。     

Surgical treatment of vascular malformations of the extremities in children and adolescents

The treatment of vascular malformations (VM) of the extremities is controversial. Six patients with large, localized, symptomatic VMs of the extremities underwent surgical excision. In five cases abnormal vessels were apparent under the skin; in two of these there was also red discoloration of the skin secondary to skin involvement. Magnetic resonance imaging was the most helpful imaging modality in evaluating these patients. Subfascial resection was performed in five cases. Muscle was involved in four patients and was removed in all four cases. At follow-up, there was improvement in symptoms and function with no clinically apparent recurrence an average of 30 months following the operation. There was improvement in pain intensity from an average of 4.3 on a scale of 1 to 10 before surgery to 1.3 after surgery. Surgical excision of localized VMs that are extensive and include fascia and muscle, as appropriate, can successfully improve pain and function without evidence of recurrence at 1 to 5 years of follow-up. Accepted: 18 January 2001     

血管母细胞瘤的临床和病理学特点

目的 分析血管母细胞瘤的临床和病理学特点,提高手术疗效。方法 回顾性分析我院1970—1998年间手术和病理证实的72例血管母细胞瘤(共95个肿瘤)患者的临床资料。结果 本病的好发年龄在20—40岁,共47例(占58．3％);男性(46例)约为女性(26例)的2倍;好发于小脑半球(83个占87．4％)有遗传倾向,少数有典型家族史。本组囊壁结节型61个(67．4％)、实质型31个、囊旁结节型3个;目前诊断主要依靠CT和MR,实质性者借助于椎动脉造影鉴别。手术治疗是有效而可靠的方法。结论 血管母细胞瘤是良性肿瘤,手术切除是最好的治疗方法,彻底切除可治愈。放射治疗、化疗基本无效。初发年龄轻、有遗传倾向、探查失误和肿瘤切除不彻底是复发的关键。     

平阳霉素与地塞米松联合治疗婴幼儿面部血管瘤

目的:探索和评价平阳霉素和地塞米松联合注射治疗婴幼儿面部血管瘤的疗效。方法:用平阳霉素8 mg 地塞米松5 mg 2%利多卡因2 ml 生理盐水2 ml溶解后行瘤体内注射至肿胀发白为宜,注射剂量以0.2~0.3 mg/kg计算。2~3周注射1次,1个疗程3~5次。结果:术后随访12~18个月,有效率100%,治愈率和好转率是95.65%。结论:平阳霉素联合地塞米松注射治疗婴幼儿面部血管瘤是一种简便易行、安全可靠的治疗方法。