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- 郑家伟主任医师 教授
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医院:
上海交通大学医学院附属第九人民医院
科室:
口腔颌面外科
- 血管瘤治疗中应注意的几个问题
- 作者:郑家伟|发布时间:2012-11-05|浏览量:2043次
血管瘤消退并不代表消失
血管瘤可以简单分为消退型和不消退型2类。3岁时30%消退,5岁时50%消退,7岁时70%消退,9岁时90%消退,但这些数据仅是估计。当然,文献报道的消退率各不相同,血管瘤消退的可能性多是猜测。多发性血管瘤,每个病变的消退速度不一。更重要的是,血管瘤能否消退,消退后会不会引起美观问题,尚不能预测。多数报道表明,近50%的血管瘤会造成永久畸形。家长应当明白,消退并不意味着完全消失(Involute does not mean disappearance)。上海交通大学医学院附属第九人民医院口腔颌面外科郑家伟
激光不是魔术(Lasers are not magic)
血管瘤患儿家长总是希望将病变立即清除,对激光治疗寄予厚望。须知,脉冲染料激光的平均穿透深度为1.2mm,但常被用来治疗10倍于其厚度的血管瘤。潜行分离的皮肤如用激光治疗,通常导致边缘坏死。应当鼓励家长,将激光治疗作为残留的毛细血管扩张的最终治疗手段,特别是鼻、唇病变。
强调药物治疗
家长应当明白,口服类固醇激素是经时间考验的血管瘤治疗方法之一。但短期应用普萘洛尔(3~9个月)十分有效,已经取代激素作为一线治疗。小于3个月的患儿,服药前先咨询心脏科医师,测量基线数据,包括拍照、超声检查、血常规、EKG等。住院1天,观察服药后有无心动过缓、低血压、低血糖,按2~3mg/kg•d、分2~3次服药,连服3~9个月。3~4周内逐渐停药。对眶周血管瘤,可局涂1%普萘洛尔乳霜,或0.5%噻吗洛尔。
Parents should be made aware that systemic steroid treatment is one of the few therapies for hemangiomas that have been time-tested. More recently, propranolol for short-term use (3?9 months) has been highly effective and has replaced steroids as first-line treatment. In infants younger than 3 months, starting the medication requires hospital admission to watch for bradycardia, hypotension, and hypoglycemia, though just for 1 day. Preoperatively, photographs, ultrasound, routine blood work, and a cardiology visit (for echo and EKG) are required. The drug works well if started at 2 to 3 mg/kg/d, divided into 2 or 3 doses, and can be used for 3 to 9 months. Gradual discontinuation can take 3 to 4 weeks. Results can be grippingly rapid, and the literature certainly supports its use. Topical propranalol as a 1% cream or timolol 0.5% can be tried for some lesions around the eye to jump-start involution.