Walker R S, Custer P L, Nerad J A
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO.
Ophthalmology. 1994 Aug;101(8):1333-40. doi: 10.1016/s0161-6420(94)31165-1.
Periorbital capillary hemangiomas of childhood can produce ptosis, strabismus, and anisometropia, resulting in amblyopia. Traditional therapy with either systemic or local corticosteroids occasionally yields incomplete resolution of these lesions and may be associated with numerous adverse complications. The authors report their experience performing surgical resection of periorbital capillary hemangiomas.
Twelve children with periorbital capillary hemangiomas were treated surgically. Six of these children had previously failed to adequately respond to steroid injections and six were primarily treated with surgical resection. All lesions were believed to be localized and did not appear to be infiltrative on preoperative computed tomographic scans.
All lesions were completely resected, except for two in which there was a small area of residual hemangioma surrounding the lacrimal drainage system that was left intact. Controlled intraoperative hemorrhage in two patients required intraoperative directed-donor blood transfusion. Perioperatively, in one patient a wound dehiscence developed, which required minor repair. This same patient elected to have surgical scar revision postoperatively. The patients have been followed up to 5 years. All did well with improved cosmesis, and they have good lid function. No recurrences have been noted.
Surgical resection of pediatric capillary hemangiomas should be considered a treatment option in those that fail to respond to corticosteroids and/or are isolated and noninfiltrative in nature.
儿童眶周毛细血管瘤可导致上睑下垂、斜视和屈光参差，进而引起弱视。传统的全身或局部使用皮质类固醇治疗，这些病变偶尔不能完全消退，且可能伴有许多不良并发症。作者报告了他们进行眶周毛细血管瘤手术切除的经验。
12例眶周毛细血管瘤患儿接受了手术治疗。其中6例患儿先前对类固醇注射反应不佳，6例主要接受手术切除治疗。所有病变术前计算机断层扫描显示为局限性，无浸润表现。
除2例泪道系统周围有一小片残留血管瘤区域未切除外，所有病变均完全切除。2例患者术中出血需要术中直接输血。围手术期，1例患者出现伤口裂开，需要进行小手术修复。该患者术后选择进行手术瘢痕修复。对患者进行了长达5年的随访。所有患者外观改善，眼睑功能良好，未见复发。
对于对皮质类固醇无反应和/或孤立且无浸润性的小儿毛细血管瘤，应考虑手术切除作为一种治疗选择。
