Léauté-Labrèze C
Unité de dermatologie pédiatrique, centre de référence maladies rares de la peau, hôpital Pellegrin-Enfants, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Arch Pediatr. 2013 May;20(5):517-22. doi: 10.1016/j.arcped.2013.01.052. Epub 2013 Mar 6.
Infantile hemangioma (IH) is not strictly speaking a tumor, but the result of anarchic postnatal vasculogenesis. Hypoxia seems to play an important role as a predisposing factor. IHs can present three clinical morphologies: superficial, deep, or mixed. Localized IHs are oval or round, circumscribed lesions, whereas segmental IHs extend across a large anatomic area with a geographic shape. Localized IHs are often benign, except when they are located near a noble structure such as the airways or the orbital area. Segmental IH may be associated with birth defects (PHACES syndrome and SACRAL syndrome). Clinical follow-up of infants with IH should be very careful in the first weeks of life since 80% of all IHs have reached their final size at 5 months of age. The main indications for treatment of IHs are: life-threatening conditions (heart failure, respiratory distress), functional risks (amblyopia, swallowing disorders, etc.), aesthetic risks (especially IH of the face localized on the nose, lips, etc.), and painful ulcerated IH. Beta-blockers, namely propranolol, have quickly become the first-line therapy of complicated IH. The treatment should be given as soon as possible to avoid sequelae.
严格来说，婴儿血管瘤（IH）并非肿瘤，而是出生后血管无节制生成的结果。缺氧似乎作为一个诱发因素发挥着重要作用。婴儿血管瘤可呈现三种临床形态：浅表型、深部型或混合型。局限性婴儿血管瘤为椭圆形或圆形、边界清晰的病变，而节段性婴儿血管瘤则呈地理形状跨越较大的解剖区域。局限性婴儿血管瘤通常为良性，除非位于气道或眼眶区域等重要结构附近。节段性婴儿血管瘤可能与出生缺陷（PHACES综合征和SACRAL综合征）相关。对患有婴儿血管瘤的婴儿进行临床随访在其生命的最初几周应非常谨慎，因为所有婴儿血管瘤中有80%在5个月大时已达到其最终大小。婴儿血管瘤的主要治疗指征为：危及生命的情况（心力衰竭、呼吸窘迫）、功能风险（弱视、吞咽障碍等）、美观风险（尤其是位于面部鼻子、嘴唇等部位的婴儿血管瘤）以及疼痛性溃疡型婴儿血管瘤。β受体阻滞剂，即普萘洛尔，已迅速成为复杂性婴儿血管瘤的一线治疗方法。应尽早进行治疗以避免后遗症。
