Greene Arin K, Rogers Gary F, Mulliken John B
Division of Plastic Surgery and Vascular Anomalies Center, Children's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.
Plast Reconstr Surg. 2004 Jan;113(1):53-60. doi: 10.1097/01.PRS.0000099377.84921.E0.
Most problematic infantile hemangiomas are successfully treated with pharmacological therapy. However, there are reports that hemangioma of the parotid gland responds poorly to corticosteroid and interferon. To better clarify the management of parotid hemangioma, the authors retrospectively studied the records of 100 consecutive patients, seen between 1975 and 2002. The characteristics of the tumor, including sex ratio, presence at birth, size, side, complications, and involvement of adjacent structures, were recorded. The indications for and response to treatment and the need for surgical procedures were documented and statistically analyzed. The female-to-male ratio was 4.5:1. Forty percent of parotid hemangiomas were on the right side, 36 percent were on the left, and 24 percent were bilateral. Forty-five percent of patients had a premonitory cutaneous lesion at birth. Fifty-nine percent of parotid hemangiomas ulcerated during the early proliferative phase. Eighty-eight percent involved nearby structures (ear, 70 percent; lip, 34 percent; subglottic region, 21 percent; eye, 18 percent; and nose, 3 percent). Seven percent of patients required tracheostomy, and 3 percent had signs of congestive heart failure. Seventy infants received pharmacological treatment. Sixty-seven patients were initially managed with corticosteroids; regression or stabilization was noted in 83 percent of tumors (56 of 67 tumors). Twenty-one patients received interferon: 11 in whom corticosteroid therapy had failed, seven in whom the tumor stabilized with corticosteroid therapy but further regression was needed, and three who had interferon as primary therapy. Ninety-five percent of the lesions that were resistant to corticosteroid subsequently responded to interferon alfa-2a or -2b. The overall response rate to pharmacological therapy was 98 percent. A reconstructive procedure was necessary during the involuting or involuted phase in 66 percent of patients: 92 percent had preauricular excision of redundant skin and/or fibrofatty tissue and 37 percent of patients had auricular revision. In summary, drug therapy was effective in the majority of infants with parotid hemangioma, whether given because the tumor was large, deforming, ulcerated, or involved nearby structures with functional consequences. Infantile hemangioma in the parotid gland responded to pharmacological treatment in a similar manner as hemangioma in other locations.
大多数有问题的婴儿血管瘤通过药物治疗可成功治愈。然而，有报道称腮腺血管瘤对皮质类固醇和干扰素反应不佳。为了更好地明确腮腺血管瘤的治疗方法，作者回顾性研究了1975年至2002年间连续收治的100例患者的病历。记录了肿瘤的特征，包括性别比例、出生时是否存在、大小、部位、并发症以及相邻结构的受累情况。记录了治疗的适应证、治疗反应以及手术需求，并进行了统计分析。男女比例为4.5:1。40%的腮腺血管瘤位于右侧，36%位于左侧，24%为双侧。45%的患者出生时伴有先兆性皮肤病变。59%的腮腺血管瘤在早期增殖期发生溃疡。88%的血管瘤累及附近结构（耳部，70%；唇部，34%；声门下区域，21%；眼部，18%；鼻部，3%）。7%的患者需要气管切开术，3%的患者有充血性心力衰竭的体征。70例婴儿接受了药物治疗。67例患者最初采用皮质类固醇治疗；83%的肿瘤（67例中的56例）出现消退或稳定。21例患者接受了干扰素治疗：11例皮质类固醇治疗失败的患者，7例皮质类固醇治疗后肿瘤稳定但需要进一步消退的患者，以及3例以干扰素作为初始治疗的患者。95%对皮质类固醇耐药的病变随后对α-2a或α-2b干扰素产生反应。药物治疗的总体有效率为98%。66%的患者在消退期或消退后阶段需要进行重建手术：92%的患者进行了耳前多余皮肤和/或纤维脂肪组织切除术，37%的患者进行了耳部修复。总之，药物治疗对大多数腮腺血管瘤婴儿有效，无论治疗是因为肿瘤较大、有畸形、溃疡，还是累及附近结构并产生功能后果。腮腺婴儿血管瘤对药物治疗的反应与其他部位的血管瘤相似。
