Burgos L, López Gutiérrez J C, Andrés A M, Encinas J L, Luis A L, Suárez O, Díaz M, Ros Z
Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.
Cir Pediatr. 2007 Apr;20(2):83-6.
Hemangiomas are the most common benign tumours in infancy. Its trophoblastic origin is now confirmed and it would explain their increasing incidence that runs parallel to the more frequent use of fertilization in vitro techniques and the high rates of prematurity and twinning. It is not a coincidence that they appear more often in the face and its location is related to the merging lines of the facial embryonal buds. Nose tip, upper-eyelid and orbital regions are special areas that need a different approach in each case. Over the last years we changed our therapy protocol for these tumours, in an attempt to decrease the psychological, social and scholar impact in children.
During the last 20 years, 36 patients with nasal tip hemangiomas underwent surgical treatment in our institution. We divided them into two groups, those treated between 1985 and 1992 (n=l1) and those treated between 1992 and 2005 (n=25). Traditionally, conservative management including close observation, corticosteroid therapy and finally surgical treatment of the sequelae, was proposed. Late surgical treatment was reserved for incompletely regressed or unsuccessfully treated facial tumours. Our more recent approach involves early surgical excision, in order to avoid psychological distress and cosmetics defects. Age at diagnosis, appearance at that moment, sort of treatment and time of surgical procedure were recorded to evaluate long-term results.
In this paper we report our series of 36 patients, consisting of 26 females and 10 males, with a mean age of 5 +/- 2 months at the first visit. In 11 patients from the first period (1985-1992), corticosteroid therapy was applied waiting the spontaneous regression and they finally underwent delayed surgical treatment at a mean age of 8 years. In the remaining 25 patients treated in the second period, early surgical excision was carried out with a mean age of 3 years and before school age. Indications for corticosteroid therapy include uncontrolled growth and complications (ulceration).
The approach to management of nasal tip hemangiomas should be individualized and must take into account their depth, location, rate of involution and functional disturbance. Children age as well as psychological problems arising from the presence of proliferative hemangioma must be considered when deciding a surgical approach. Upon the high rates of scholar failure in children with deforming hemangiomas, the lack of response to medical therapy and the need of surgical treatment in all cases, our policy now it is to attempt surgical excision and reconstruction before school age. Based on data reported and on our own experience, we consider that very early surgical treatment improves quality of life of our patients and their families.
血管瘤是婴儿期最常见的良性肿瘤。其滋养层起源现已得到证实，这也解释了其发病率不断上升的现象，这一现象与体外受精技术的更频繁使用以及早产和双胎率高并行。它们更常出现在面部并非巧合，其位置与面部胚胎芽的融合线有关。鼻尖、上眼睑和眼眶区域是特殊区域，每种情况都需要不同的处理方法。在过去几年中，我们改变了这些肿瘤的治疗方案，试图减少对儿童的心理、社会和学业影响。
在过去20年中，我们机构对36例鼻尖血管瘤患者进行了手术治疗。我们将他们分为两组，1985年至1992年治疗的患者（n = 11）和1992年至2005年治疗的患者（n = 25）。传统上，提出了保守治疗方法，包括密切观察、皮质类固醇治疗以及最终对后遗症进行手术治疗。晚期手术治疗适用于面部肿瘤未完全消退或治疗失败的情况。我们最近的方法是早期手术切除，以避免心理困扰和美容缺陷。记录诊断时的年龄、当时的外观、治疗方式和手术时间，以评估长期结果。
在本文中，我们报告了我们的36例患者系列，其中包括26名女性和10名男性，首次就诊时的平均年龄为5±2个月。在第一阶段（1985 - 1992年）的11例患者中，应用皮质类固醇治疗等待自然消退，他们最终在平均8岁时接受了延迟手术治疗。在第二阶段治疗的其余25例患者中，平均年龄为3岁且在入学前进行了早期手术切除。皮质类固醇治疗的指征包括生长失控和并发症（溃疡）。
鼻尖血管瘤的治疗方法应个体化，必须考虑其深度、位置、消退速度和功能障碍。在决定手术方法时，必须考虑儿童的年龄以及增殖性血管瘤引起的心理问题。鉴于患有变形血管瘤的儿童学业失败率高、对药物治疗无反应以及所有病例都需要手术治疗，我们现在的政策是在入学前尝试手术切除和重建。根据报告的数据和我们自己的经验，我们认为非常早期的手术治疗可改善患者及其家人的生活质量。
