David Lisa R, Malek Marc M, Argenta Louis C
Department of Plastic and Reconstructive Surgery, Baptist Medical Center, Wake Forest University, Medical Center Blvd, Winston-Salem, NC 27157-1075, USA.
Br J Plast Surg. 2003 Jun;56(4):317-27. doi: 10.1016/s0007-1226(03)00152-8.
Haemangiomas are common vascular lesions occurring in up to 10-12% of infants by 1 year of age. Typically, these lesions are treated expectantly unless complicated by haemorrhage, ulceration, infection, or compromise of adjacent vital structures. Ulceration is a particularly difficult problem because of associated pain, infection, haemorrhage, and subsequent scarring.
Seventy-eight children (54 girls, 24 boys) with ulcerated haemangiomas, from our vascular malformation clinic were enrolled in a prospective pulse dye laser treatment protocol from April of 1995 to November of 2001. The mean size of the ulcerated haemangiomas requiring treatment was 21 cm2. Lesions were treated with minimal debridement and the Cynosure pulse dye laser with a mean energy of 6.6 J, and a mean number of 173 pulses per treatment. Lesions were treated in a sequential pattern at 3-4 week intervals until cutaneous healing or involution of the haemangioma occurred.
Seventy-one of the 78 patients (91%) responded to laser therapy alone with a mean number of 2.0 treatments. Six patients with very large haemangiomas required oral steroids (2-3 mg/kg/day) in combination with the pulse dye laser. After failing to improve on steroid therapy, two patients required the addition of interferon to their treatment protocol. The mean follow up time is 15 months with no sign of recurrent ulceration or regrowth of the haemangiomas in our study population.
Pulse dye laser therapy is a reasonably effective means of resolving the untoward complication of ulceration of haemangiomas. We report the largest series to date of ulcerated haemangiomas treated with this modality.
血管瘤是常见的血管性病变，1岁时发病率高达10% - 12%。通常，这些病变采取观察等待的治疗方式，除非出现出血、溃疡、感染或危及相邻重要结构等并发症。溃疡是一个特别棘手的问题，因为会伴有疼痛、感染、出血以及后续的瘢痕形成。
1995年4月至2001年11月，我们血管畸形门诊的78例患有溃疡型血管瘤的儿童（54例女孩，24例男孩）纳入了一项前瞻性脉冲染料激光治疗方案。需要治疗的溃疡型血管瘤平均大小为21平方厘米。病变采用最小限度清创，并使用赛诺秀脉冲染料激光治疗，平均能量为6.6焦耳，每次治疗平均脉冲数为173次。病变以3 - 4周的间隔依次治疗，直至皮肤愈合或血管瘤消退。
78例患者中有71例（91%）仅接受激光治疗有效，平均治疗次数为2.0次。6例患有非常大的血管瘤的患者需要联合口服类固醇（2 - 3毫克/千克/天）与脉冲染料激光治疗。在类固醇治疗无效后，2例患者在治疗方案中添加了干扰素。我们研究人群的平均随访时间为15个月，未发现血管瘤复发性溃疡或再生长的迹象。
脉冲染料激光治疗是解决血管瘤溃疡这一不良并发症的一种相当有效的方法。我们报告了迄今为止用这种方式治疗溃疡型血管瘤的最大系列病例。
