平阳霉素局部注射治疗婴幼儿眼睑血管瘤18例临床分析.docx

【摘要】? 目的 观察平阳霉素局部注射治疗婴幼儿眼睑血管瘤的临床效果。方法 采用平阳霉素局部注射法治疗18例眼睑血管瘤患儿(男7例,女11例),将平阳霉素均匀注射至血管瘤瘤体内。结果 18例中, 除1例因病变面积大, 注射8次平阳霉素(总剂量29 mg) 外,其余17例患儿注射1～5次后,血管瘤消失。用药后局部反应轻,仅为轻度组织肿胀,一般3天后逐渐消肿,15天后皮肤色泽渐趋于正常,3个月后组织恢复正常弹性及形态。随访观察8～36个月,15例瘤体全部消失。未见局部感染、组织坏死及瘢痕。结论 应用平阳霉素局部注射治疗婴幼儿眼睑血管瘤,绝大部分效果显著,具有损害小、瘢痕轻、外观效果较好等特点。 【关键词】? 眼睑血管瘤;婴幼儿;平阳霉素　　Abstract:Objective To observe the clinical efficacy of local injection of pingyangmycin in the treatment of infantile eyelid hemangioma. Methods 18 cases (7 males and 11 females) of infantile eyelid hemangioma received local injection of pingyangmycin into the tumor. Results After 1-5 times of injection, hemangioma disappeared in 17 of 18 cases. But 8 times of injection (total dose of 29 mg pingyangmycin) were performed in 1 case because the tumor was too large. Most cases had mild reaction, such as tissue swelling, which often dispeared after 3 days. The skin color turned from red to white after 15 days. The tissue became normal after 3 months. During 8-36 months follow-up, hemangioma disappeared completely in 15 cases without infection, necrosis and scar. Conclusions Local injection of pingyangmycin is proved effective to most cases of infantile eyelid hemangioma, with minor tissue damage, mild scar formation and good appearance.　　Key words： eyelidhemangioma; infant; pingyangmycin　　海绵状血管瘤是眼睑常见的血管病变,特别是发生于1岁以内婴幼儿的海绵状血管瘤，其生长尤为迅速。婴幼儿眼部血管瘤虽属良性,但可出现诸多的并发症,如溃烂、出血、感染等[1]。尤其是眼睑、眉部、泪囊区血管瘤,可严重影响患者的美容及局部功能,血管瘤位于上睑者可随瘤体的增大而导致上睑下垂,引起弱视、斜视及屈光不正等。以往对其治疗曾用冷冻、放射线、手术、注射硬化剂、激光等方法，都存在一些不足之处，有的还存在较严重的不良反应或并发症，如眼睑皮肤萎缩、瘢痕、泪腺萎缩及放射性白内障等[2-3]。我们采用抗肿瘤药物平阳霉素局部注射治疗18例婴幼儿眼睑血管瘤患儿取得了良好效果,现报道如下。　　1 资料和方法　　1.1 对象 选择本院门诊18例眼睑血管瘤婴幼儿患者,男7例,女11例;年龄3个月～6岁。右上睑9例，右下睑2例，左上睑6例，左下睑1例。其中大部分发生在眉与睑缘间，有2例延伸至睑结膜、穹窿结膜;最大的约1.5 cm，最小的约0.3 cm。　　1.2 术前检查 术前血常规、出凝血时间、肝肾功能及X线胸透等检查均正常。对面积大、位置深的血管瘤患儿常规行眼眶CT或MRI及B超检查。　　1.3 方法 术前作普鲁卡因皮试，阴性者用20 g/L普鲁卡因2 ml溶解平阳霉素8 mg，穿刺瘤体回抽见血后(少部分无回血)，将药物注入至瘤体全部或部分变苍白肿胀，注射后用棉棒轻压进针部位3～5 min，注射剂量视瘤体的大小、深浅而定。每3～4周注射1次，直至瘤体消失，每2～3个月复诊1次，随访8～36个月。注意事项：①注射应在瘤体范围内，每次不超过8 mg;②每次注射充分做