Canavese Federico, Soo Brendan C L, Chia Samuel K K, Krajbich Joseph Ivan
Department of Pediatric Orthopedics, Shriners Hospital, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA.
J Pediatr Orthop. 2008 Apr-May;28(3):381-6. doi: 10.1097/BPO.0b013e318168d1a7.
Hemangiomas are the most common tumors in infancy and childhood and account for 7% of benign soft tissue tumors. Diagnosis is usually made in infancy or childhood. There are only a few reports on the surgical treatment of these lesions, likely because the lesions are quite vascular, have a tendency to infiltrate into the muscle and other tissues, and the recurrence rate is quite high.
We reviewed the outcome of surgical treatment on 44 consecutive children and adolescents with 47 surgically treated hemangiomas. Hemangiomas involving the face and the head were excluded.
Eleven lesions were surgically treated before the age of 5 years, 20 lesions between the ages of 5 and 12 years, and 16 lesions were treated after the age of 12 years. Eleven lesions had intralesional resection, 33 lesions underwent marginal resection, 2 lesions were managed with wide resection, and 1 lesion underwent radical resection. The overall recurrence rate was 22.2%.
In the pediatric population, it is desirable to perform definitive treatment whenever possible, thereby minimizing morbidity, both functional and psychological. Asymptomatic lesions should be monitored to confirm the diagnosis and to look for signs of progression. Symptomatic lesions can be treated with surgical excision if this does not result in significant functional impairment. A marginal resection may be used to treat most superficial soft tissue tumors. Intramuscular hemangiomas pose a more difficult therapeutic problem. When the lesion is limited in size, it may be treated with wide local excision. However, if the lesion is more diffusely spread into the muscle unit, the morbidity created by extensive muscle resection has to be weighed against the morbidity of the condition or alternative treatment methods. Whenever possible, a wide marginal resection should be carried out to minimize the risk of recurrence and avoid further surgical procedures. We recommend prolonged follow-up of these patients because 7% of the patients included in this study required late review due to multiple recurrences of these lesions.
Level IV (case series).
血管瘤是婴幼儿期最常见的肿瘤，占良性软组织肿瘤的7%。通常在婴幼儿期或儿童期确诊。关于这些病变的手术治疗报告较少，可能是因为病变血管丰富，易于浸润肌肉和其他组织，且复发率相当高。
我们回顾了44例连续的儿童和青少年手术治疗47例血管瘤的结果。排除累及面部和头部的血管瘤。
11例病变在5岁前接受手术治疗，20例病变在5至12岁之间接受手术治疗，16例病变在12岁后接受手术治疗。11例病变行瘤内切除，33例病变行边缘切除，2例病变行广泛切除，1例病变行根治性切除。总体复发率为22.2%。
在儿科人群中，尽可能进行确定性治疗，从而将功能和心理方面的发病率降至最低。无症状病变应进行监测以确诊并寻找进展迹象。有症状的病变如果不会导致明显的功能损害，可通过手术切除进行治疗。边缘切除可用于治疗大多数浅表软组织肿瘤。肌内血管瘤带来更棘手的治疗问题。当病变体积有限时，可采用广泛局部切除治疗。然而，如果病变更广泛地扩散到肌肉单元，必须权衡广泛肌肉切除所带来的发病率与病情或替代治疗方法的发病率。只要有可能，应进行广泛的边缘切除以将复发风险降至最低并避免进一步的手术。我们建议对这些患者进行长期随访，因为本研究中7%的患者因这些病变多次复发而需要后期复查。
IV级（病例系列）。
