浅表血管瘤和脉管畸形的手术治疗(1)
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[摘要]目的：評估手术切除方法对浅表血管瘤和脉管畸形的治疗效果。方法：对各部位位置表浅、界限清楚的血管瘤和静脉畸形、淋巴管畸形行手术切除，继发软组织缺损行直接缝合、局部皮瓣转移或植皮修复。结果：本组病例共91例，血管瘤56例，静脉畸形30例，淋巴管畸形5例；55例血管瘤1次手术切除，1 例经2次手术切除；25例浅表静脉畸形1次手术切除，2例经2次手术切除，2例残余部分给予注射平阳霉素治愈；5例淋巴管畸形均1次手术切除。直接缝合63 例，行局部皮瓣转移修复20例，植皮修复18 例。随访时间分别为3个月～7年，所有病例均无复发，修复部位外形恢复良好。结论：对于诊断确切、界限清楚的浅表血管瘤和脉管畸形，手术切除是一种有效的治疗方法。
[关键词]血管瘤；脉管畸形；静脉畸形；淋巴管畸形；手术治疗
[中图分类号]R732.2[文献标识码]A[文章编号]1008-6455(2011)09-1424-02
Surgerytreatmentofsuperficialhemangiomasandvascularmalformations
YANG Yun，WANG Ji-hua，ZHANG Jing-bo，ZHU Li-kun，GUO Qun，XIAO Hong，HE Yong-jing
(Department of Plastic Surgery，The Second Affiliated Hospital of Kunming Medical College, Kunming 650101，Yunnan，China)
Abstract：Objective To evaluate the treatment effects of the surgical methods for superficial hemangiomas and vascular malformations.Methods The superficial and clear boundary hemangioma 、Venous Vascular Malformations、lymphatic malformations been resceted.Secondary soft tissue defects were sutured directly or repaired with local skin flap or skin grafting.Results A total of 91 patients in this group of patients,56 cases of hemangioma，30 cases of venous malformation,5 cases of lymphatic malformation. 55 vascular malformations were resected once,1 was resected twice.25cases of superficial venous malformation were resected once，2 cases were resected twice,2 cases of the residual parts were cured by giving Bleomycin injection,5 cases of lymphatic malformations were resected once.53 cases by direct suture,20 cases repaired by local flab transfer,18 cases by skin grafting.Follow-up time was 3 months to 7 years,all patients had no recurrence,apprearance of repaired parts recovered well. ConclusionSurgical resection is an effected treatment for superficial hemangiomas and vascular malformations with definite diagnoses and clear boundary.
Key words：hemangioma； vacular malformations； arteriovenous malformation； surgery lymphatic malformations
血管瘤和脉管畸形是婴幼儿比较常见的血管性疾病，治疗方法也很多，应根据患者的年龄、病变类型及病变部位等因素决定。2000年以来，笔者科室对身体各部位位置表浅、界线清楚的血管瘤和静脉畸形、淋巴管畸形行手术切除，取得很好的治疗效果，现报道如下：
1资料和方法
1.1 一般资料：本组共91例，血管瘤56例，浅表静脉畸形30例，淋巴管畸形5例。其中男35例，女56例，年龄5个月～62岁，病程5个月～60年，病变分布于头面颈部77例，四肢10例，躯干4例。病变范围为1cm×1cm～18cm×22cm。
1.2 术前准备：除常规行血生化、胸片、心电图检查外，根据病变情况行彩色超声、CT增强扫描或MRI检查，对考虑为动静脉畸形的行DSA造影，通过以上检查明确病变性质、累及的范围和界限，对于小儿和病变较大、术中出血多的病例备全血100～300ml。
1.3 手术方法：①血管瘤往往突出于皮肤表面，手术时先在瘤体内注入肾上腺素盐水，在瘤体周围正常组织内切开，由瘤体周边向中心部位剥离、结扎供应血管，完整切除病变。继发创面行直接缝合、邻位皮瓣植皮修复；②浅静脉畸形：根据术前影像学显示病灶范围用美兰作标记，先在术区注入1/20万肾上腺素生理盐水使“瘤体”肿胀 ......
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