Picard A, Soupre V, Diner P A, Buis J, Goga D, Vazquez M P
Service de Chirurgie Maxillo-Faciale, CHU Trousseau, 37044 Tours.
Rev Stomatol Chir Maxillofac. 2002 Feb;103(1):10-21.
The natural course of immature hemangiomas in infants is well-known. A rapid phase of growth from 6 to 8 months is followed by a period of stability then regression. Since approximately 70% of these immature hemangiomas resolve spontaneously, abstention is generally the rule. The volume or localization of certain lesions may nevertheless have a serious functional or morphological impact.
This retrospective study included 81 children who underwent surgery between October 1994 and March 2000. The children were aged 2 to 38 months at the time of surgery. Orbital localizations predominated (33 children). The indication for surgery was based on two criteria: risk of a functional impairment or risk of morphological sequela. All children with orbital hemangiomas with a functional risk of amblyopia were initially treated with corticosteroids. Surgery was performed in case of failure. The CAVITRON was used for 77 children and DISSECTRON for 4. These two ultrasound devices allowed easy dissection with little hemorrhage.
There were no peroperative hemorrhagic complications. Few postoperative complications were observed. After resection of the orbital hemangiomas there was little functional impact and the postoperative ophthalmologic examinations were normal within several weeks. Mean follow-up was 12 months after surgery. Use of an ultrasound dissector allowed early and safe treatment of immature hemangiomas.
Certain voluminous or poorly localized hemangiomas, particularly on the face, can have a serious function, morphological or psychological impact. Medical treatment is not always active and surgical resection may be required before the development of definitive sequelae. Ultrasound dissection, not previously used in this indication, can contribute significantly to the surgical outcome as demonstrated in these children operated on early. This technique is safe and shortens operative time. In light of these results, we believe early resection of immature hemangiomas should be reevaluated. It should not be considered as a last resort but rather as a complementary treatment.
婴儿期未成熟血管瘤的自然病程已为人熟知。在6至8个月时有一个快速生长阶段，随后是稳定期，然后逐渐消退。由于这些未成熟血管瘤中约70%会自发消退，一般原则是采取观察等待。然而，某些病变的体积或位置可能会产生严重的功能或形态学影响。
这项回顾性研究纳入了1994年10月至2000年3月期间接受手术的81名儿童。手术时儿童年龄为2至38个月。眼眶部位的病变占多数（33名儿童）。手术指征基于两个标准：功能损害风险或形态学后遗症风险。所有有弱视功能风险的眼眶血管瘤患儿最初均接受皮质类固醇治疗。若治疗失败则进行手术。77名儿童使用了CAVITRON，4名儿童使用了DISSECTRON。这两种超声设备便于进行解剖且出血少。
术中无出血并发症。术后观察到的并发症很少。眼眶血管瘤切除术后功能影响很小，术后几周内眼科检查正常。术后平均随访12个月。使用超声解剖器可对未成熟血管瘤进行早期且安全的治疗。
某些体积较大或位置不佳的血管瘤，尤其是面部的血管瘤，可能会产生严重的功能、形态学或心理影响。药物治疗并非总是有效，可能需要在出现明确后遗症之前进行手术切除。超声解剖此前未用于此适应证，如这些早期接受手术的儿童所示，它可显著改善手术效果。该技术安全且缩短了手术时间。鉴于这些结果，我们认为应重新评估未成熟血管瘤的早期切除。不应将其视为最后手段，而应作为一种补充治疗方法。
