体表巨大血管瘤综合治疗.docVIP

体表巨大血管瘤综合治疗【摘要】 目的 总结体表巨大血管瘤的最佳治疗方案。方法 2004~2009年附属医院整形外科治疗体表巨大血管瘤54例。其中23例行术前血管介入栓塞,后行手术切除创面修复,31例直接行手术切除后创面修复。术中均进行周边缝扎、肾上腺素盐水浸润、电凝止血等辅助手段。术后复发病例进行平阳霉素局部注射治疗。结果 术后随访6个月到4年,31例单纯行手术切除治愈26例(83.8%),复发5例;23例术前介入栓塞者治愈21例(91.3%)复发2例。平阳霉素注射后未见复发。治愈率100%。结论 选择性血管介入栓塞,术中间断缝扎、肾上腺素盐水浸润、电凝止血等有效的止血方法配合进行手术、术后平阳霉素局部注射是综合治疗体表巨大血管瘤一种效果良好的方法。? 【关键词】 血管瘤;介入栓塞;手术治疗 ?? The compremhensive Combined Therapy Of The Body Surface Giant Hemangioma LIAN Jie, WU Zhi-xian, ZHANG Wen-guang,et al. Departerment of Plastic-Surgery, Affiliated Hospital of Guangdong Medical College, Guangdong 524001,China ? 【Abstract】 Objective To summary the experience of treating the body surface giant hemangioma. Methods From 2004 to 2009 54 cases of body surface giant hemangioma were treated. Among 54 cases, 23cases selected to treat by intervention-embolization before operation, 31cases were treated by operation alone.We all used the method in operation such as silk string 、sympathetic hormone injection and electric coagulation. Results Followed up from 6 months to 4 years, 31 cases had received surgery,26 were recovery 91.3 and 5 of them were recurrence,21 cases of postoperative recarrence out of 23 cases(93.3%)，2 cases were recurrence.7 cases of postoperative recurrence.there are no recurrence after the injection of pingyangmycin.Conclusion selective embolization of the feeding arteries before operation、silk string 、sympathetic hormone injection and electric coagulation combined with surgical resection is a good treated method for the the body surface giant hemangioma.? 【Key words】 Hemangioma;Interventional embolization;Operative treatment 血管瘤是一组常见的良性肿瘤。体表巨大血管瘤(头颈部血管瘤直径10cm,肢体或躯干20cm)[1],深度浸润到肌膜以下不仅严重的影响了人们形体美观而且部分还引起了功能障碍,然而对外科医生来说单纯手术切除一直是一种严峻的挑战,术中不仅易引发难以控制的大出血,而且病变切除范围广泛者易造成组织功能的丧失,切除范围过小者易引起术后复发。因此寻求一种理想的外科治疗方法一直是外科工作者努力的方向。? 1 临床资料? 本组54例。男29例,女25例;年龄1～45岁,平均19岁。部位为躯干7例,下肢18例,上肢29例。其中体表面积最大者达40cm~45cm,最小者15cm～10cm。? 2 手术方法? 2.1 术前准备 ①明确血管畸形的性质及范围:术前彩色多普勒超声检查、CT血