得保松联合甲氨蝶呤注射治疗婴幼儿血管瘤(1)
[摘要]目的：探索得保松联合甲氨蝶呤综合注射治疗婴幼儿血管瘤的安全有效、创伤小的方法。 方法：应用瘤体间质内得保松混合甲氨蝶呤注射，或栓塞硬化结合得保松混合甲氨蝶呤注射治疗表浅和深部血管瘤。 结果：治疗婴幼儿血管瘤共178例。皮肤的浅表血管瘤经间质内得保松及甲氨蝶呤注射治疗102例，其中共1次注射治疗消退38例，共2次治疗消退45例，共3次治疗消退19例，无1例出现皮肤破溃。深部血管瘤经栓塞硬化联合得保松混合甲氨蝶呤注射治疗72例，其中共1次治疗消退62例，共2次治疗消退10例。血管瘤合并KM综合征4例， 共1次治疗2例，共2次治疗2例血小板恢复正常，瘤体消退，无复发；栓塞硬化治疗中3例出现皮肤水泡及部分皮肤干性坏死，均自行愈合。 结论：得保松联合甲氨蝶呤瘤体间质注射或结合栓塞硬化注射治疗婴幼儿血管瘤，能够控制其快速生长，其疗效安全可靠,创伤小，形态功能恢复良好，具有美容效果。
[关键词]血管瘤；得保松；甲氨蝶呤；注射；栓塞硬化
[中图分类号]R732.2 [文献标识码]A [文章编号]1008-6455(2009)03-0346-03
, 百拇医药
Injection of Diprospan with Methotrexate (MTX) in the treatment of infantile hemangioma
OUYANG Tian-xiang,HUANG Ying-ying,CHENG Hui-ping,YU Jie,XIAO Yan,LIN Jun,ZHANG Qian
(Department of Plastic Surgery,Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)
Abstract: Objective To explore a safe, effective and minimally invasive therapy of infantile hemangioma with the combined injection of Diprospan plus Methotrexate (MTX). Methods Apply the injection of Diprospan with MTX in interstitial tissue of the hemangioma, or combine with the embolo-sclerotherapy and Diprospan plus MTX according to the depth of lesion (deep or superficial). Results 178 patients with infantile hemangioma were treated. 102 superficial lesions involving skin layers had injection of Diprospan with MTX into interstitial tissue, among which 38 patients' lesions decreased after 1 injection, 45 cases decreased after 2 injections, 19 cases decreased after 3 times of treatment, with no case of skin ulceration. 72 deep lesions had combined embolo-sclerotherapy with Diprospan plus MTX,among which 62 patients' lesions decreased after 1 injection, 10 cases decreased after 2 injections. 4 cases of Kasabach -Merritt Syndrome (KMS): 2 cases had 1 injection and other 2 had 2 injections, all showed good results with platelet count back to normal, lesions disappearance and no recurrence. 3 deep lesions got skin blisters and local dry necrosis after treatment and all healed up spontaneously. Conclusion The injection of Diprospan with MTX,or a combination of embolo-sclerotherapy and Diprospan plus MTX in treating infantile hemangioma can well control the growth of the lesion. It's a safe, effective, minimally invasive way to retain form and function, and also provides an aesthetic effect.
, 百拇医药
Key words:infantile hemangioma;diprospan;methotrexate;injection；embolo-sclerotherapy
婴幼儿血管瘤以早期快速生长、能自然消退为特征[1]，但如何达到有效控制其快速生长，又创伤小，并发症少是治疗的关键。自1990年以来，我们应用瘤体间质内得保松混合甲氨蝶呤注射，或栓塞硬化结合得保松混合甲氨蝶呤注射治疗表浅和深部血管瘤，达到了控制快速生长，形态恢复较满意的良好疗效。
1资料和方法
1.1临床资料：婴幼儿血管瘤178例(男性38例，女性140例)，年龄42天～1.5岁。浅表血管瘤102例，深部血管瘤72例，其中伴KM综合征4例。治疗前深部血管瘤做MRI以确定范围、浸润层次及与周围组织的关系。
1.2治疗方法
, 百拇医药
1.2.1血管瘤间质内注射：适于仅在皮肤的浅表血管瘤。得保松注射剂0.5ml、甲氨蝶呤5mg与1%利多卡因2ml混合，直接注射(回抽无血)血管瘤间质内，致瘤体变苍白为止。若瘤体范围大，则选择生长明显部位分点注射。若血管瘤生长未能控制，1个月后再次进行注射治疗。一般治疗总次数不超过3次，注射治疗到婴幼儿半岁左右，不超过1年。
1.2.2 栓塞硬化注射治疗联合得保松混合甲氨蝶呤注射治疗[2]：适于皮下大范围压缩性血管瘤(或皮肤同时存在浅表血管瘤)及KM综合征。压迫瘤体周围并向一侧推移瘤体，以减缓瘤体血液回流速度。瘤体中心穿刺，回抽见血，分次缓慢注射无水酒精，每次0.2～0.3ml，见回抽液中富有凝血颗粒(提示瘤体回流静脉大部分栓塞)，随即注入含得保松和甲氨蝶呤的硬化剂(10%明矾液或5%鱼肝油酸钠5ml中加入1ml得保松、5mg甲氨蝶呤，混均)。大瘤体者分点注射。治疗过程中注意观察小儿氧饱和度变化。, 百拇医药(欧阳天祥 黄莹滢 陈惠平 虞 杰 肖 燕 林 军 张 茜)
[关键词]血管瘤；得保松；甲氨蝶呤；注射；栓塞硬化
[中图分类号]R732.2 [文献标识码]A [文章编号]1008-6455(2009)03-0346-03
, 百拇医药
Injection of Diprospan with Methotrexate (MTX) in the treatment of infantile hemangioma
OUYANG Tian-xiang,HUANG Ying-ying,CHENG Hui-ping,YU Jie,XIAO Yan,LIN Jun,ZHANG Qian
(Department of Plastic Surgery,Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)
Abstract: Objective To explore a safe, effective and minimally invasive therapy of infantile hemangioma with the combined injection of Diprospan plus Methotrexate (MTX). Methods Apply the injection of Diprospan with MTX in interstitial tissue of the hemangioma, or combine with the embolo-sclerotherapy and Diprospan plus MTX according to the depth of lesion (deep or superficial). Results 178 patients with infantile hemangioma were treated. 102 superficial lesions involving skin layers had injection of Diprospan with MTX into interstitial tissue, among which 38 patients' lesions decreased after 1 injection, 45 cases decreased after 2 injections, 19 cases decreased after 3 times of treatment, with no case of skin ulceration. 72 deep lesions had combined embolo-sclerotherapy with Diprospan plus MTX,among which 62 patients' lesions decreased after 1 injection, 10 cases decreased after 2 injections. 4 cases of Kasabach -Merritt Syndrome (KMS): 2 cases had 1 injection and other 2 had 2 injections, all showed good results with platelet count back to normal, lesions disappearance and no recurrence. 3 deep lesions got skin blisters and local dry necrosis after treatment and all healed up spontaneously. Conclusion The injection of Diprospan with MTX,or a combination of embolo-sclerotherapy and Diprospan plus MTX in treating infantile hemangioma can well control the growth of the lesion. It's a safe, effective, minimally invasive way to retain form and function, and also provides an aesthetic effect.
, 百拇医药
Key words:infantile hemangioma;diprospan;methotrexate;injection；embolo-sclerotherapy
婴幼儿血管瘤以早期快速生长、能自然消退为特征[1]，但如何达到有效控制其快速生长，又创伤小，并发症少是治疗的关键。自1990年以来，我们应用瘤体间质内得保松混合甲氨蝶呤注射，或栓塞硬化结合得保松混合甲氨蝶呤注射治疗表浅和深部血管瘤，达到了控制快速生长，形态恢复较满意的良好疗效。
1资料和方法
1.1临床资料：婴幼儿血管瘤178例(男性38例，女性140例)，年龄42天～1.5岁。浅表血管瘤102例，深部血管瘤72例，其中伴KM综合征4例。治疗前深部血管瘤做MRI以确定范围、浸润层次及与周围组织的关系。
1.2治疗方法
, 百拇医药
1.2.1血管瘤间质内注射：适于仅在皮肤的浅表血管瘤。得保松注射剂0.5ml、甲氨蝶呤5mg与1%利多卡因2ml混合，直接注射(回抽无血)血管瘤间质内，致瘤体变苍白为止。若瘤体范围大，则选择生长明显部位分点注射。若血管瘤生长未能控制，1个月后再次进行注射治疗。一般治疗总次数不超过3次，注射治疗到婴幼儿半岁左右，不超过1年。
1.2.2 栓塞硬化注射治疗联合得保松混合甲氨蝶呤注射治疗[2]：适于皮下大范围压缩性血管瘤(或皮肤同时存在浅表血管瘤)及KM综合征。压迫瘤体周围并向一侧推移瘤体，以减缓瘤体血液回流速度。瘤体中心穿刺，回抽见血，分次缓慢注射无水酒精，每次0.2～0.3ml，见回抽液中富有凝血颗粒(提示瘤体回流静脉大部分栓塞)，随即注入含得保松和甲氨蝶呤的硬化剂(10%明矾液或5%鱼肝油酸钠5ml中加入1ml得保松、5mg甲氨蝶呤，混均)。大瘤体者分点注射。治疗过程中注意观察小儿氧饱和度变化。, 百拇医药(欧阳天祥 黄莹滢 陈惠平 虞 杰 肖 燕 林 军 张 茜)