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。

Head and neck hemangiomas: how and when to treat

Hemangiomas are common benign vascular tumors of infancy characterized by a proliferative growth phase followed by very slow inevitable regression (involutive phase) between one to ten years of age, about 60% to 70% of the lesions are found in the head and neck region. There are many treatment modalities reported in the literature for head and neck hemangiomas, including wait and see policy, drug therapy, sclerotherapy (steroids, bleomycin), cryotherapy, isotope radiotherapy, laser therapy, and surgical therapy. There still exist many controversies over the optimal treatment options for individual patient. Based on our clinical experience on 250 cases and literature review, a rational treatment regime for head and neck hemangioma was proposed in this study: (1) As it is not possible to predict, whether a hemangioma will remain small and unproblematic or grow into a very large lesion, early therapy is the only way out of this dilemma. A white or pink macule, a port-wine stain-like lesion initially appearing in the children can be effectively and easily removed by laser, thus preventing a growth in the size in the early stage. (2) The term of "wait and see" should be substituted by "close observation", and this approach should only be reserved for hemangiomas which are without visible growth or in the involutive phase. (3) Systematic drug therapy (steroids, interferon alpha-2a ) should be considered for large hemangioma, multiple hemangiomas, life-threatening hemangiomas and hemangiomas with complications such as ulceration, infection, bleeding, dysfunction, etc. Congestive heart failure, consumptive coagulopathy, and thrombocytopenia are also urgent indications for the institution of corticoid therapy. (4) Growing hemangioma can be treated effectively by systematic drug therapy, sclerotherapy, laser therapy or combined therapy. The argon laser (514 nm in wavelength, 0.5 mm in depth) is useful in the treatment of superficial telangiectasias and small, flat cutaneous hemangiomas. Flashlamp-pumped pulsed-dye laser (FPDL, 585 nm or 595 nm in wavelength, 1.0-2.0 mm in depth) can be used in patients with cutaneous and flat hemangiomas at the sites of potential functional impairment. Nd: YAG laser (1064 nm in wavelength) with continuous ice cube cooling is useful for subcutaneous or mixed hemangiomas, and often requires repeated treatments. For larger and deeper hemangiomas up to a depth of 2.0 cm, percutaneous interstitial Nd:YAG laser treatment may be preferred, because it may decrease possible cutaneous skin damage and more effectively reduce bulky, deep lesion. (5) Topical application of imiquimoid and intratumoral injection of steroids or bleomycin can be used in selected patients with rapidly growing hemangioma. (6) The indication for a primary operation is rare and limited to large hemangiomas in the eyelid or hemangiomas on the scalp. Surgical correction of large residuals, especially before formal education begins, to prevent considerable psychosocial impairment is still a well established procedure. The aim of treatment is to counter the proliferative growth, reduce the volume of hemangioma, and initialize the process of regression. Cryotherapy or isotope radiotherapy is nowadays seldom used for the treatment of hemangiomas, due to the high incidence of scarring, pigmentation, or depigmentation. A successful treatment of hemangiomas should be individualized and based on the size of the tumor, the localization, and the therapies available. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).