腔内注射治疗婴幼儿颌面部巨大混合性脉管畸形疗效观察［摘要］目的：探讨颌面部巨大混合性脉管畸形的综合治疗方法，评判其治疗效果。方法：2006年1月〜2011年5月，笔者科室采用平阳霉素结合A群链球菌溶液，间隔腔内注射的方法，治疗颌面及舌部巨大淋巴管畸形合并静脉畸形患者22例。先进行平阳霉素瘤腔穿刺注射，间隔5天腔内注射A群链球菌。注射平阳霉素10天后进行该药第2次注射，5天后注射第2次A群链球菌制剂。1个月后根据局部变化及瘤体大小进行下一个疗程。结果：一般2个疗程后皮损即明显缩小，颌面部畸形外观显著改善。经过3〜4个疗程治疗，患儿多可达基本治愈。结论：采用平阳霉素结合A群链球菌溶液瘤腔内注射治疗颌面部巨大混合性脉管畸形，安全可靠，疗效明显，可有效改善面部外观。［关键词］脉管畸形；颌面部；婴幼儿［中图分类号1R732.2［文献标识码］A［文章编号］1008-6455(2012)01-0091-03Intra-lesionalinjectionforthetreatmentoforalandmaxillofaciallymphatic-capillarymalformationininfantsandchildrenWUXuan-lin,GONGWei,GAOYa,LIPeng,GUOZheng-tuan,DUANYi-tao,GUOXin-kui,WANGHuai-jie(DepartmentofPediatrieSurgery,TheSecondHospitalofXianJiaotongUniversity,Xi'an710004,Shaanxi,China)Abstect：ObjectiveToevaluatetheefficacyofcombinedmodalitytherapyfororalandmaxillofacial1ymphohemangioma・MethodsBetweenJan2006andMay2011twenty-twocaseswithhugecombinedlymphatic-capi1larymalformationarisinginmaxillofacialregionandtonguewereadmittedtoourdepartment・AllthecasesweretreatedusingcombinationofGroupAStreptococcusPreparationandbleomycina5(pingyangmycin)forinjection.Thesolutionforinjectionwasinjectedintolesionsmulti-pointedlyandperiodically.Ineachcycle,atthefirstday(dl)bleomycina5wasusedforintra-lesionalinjection；atd5theGroupAStreptococcusPreparationwasinjectedintolesions；atdlOtheinjectionofbleomycina5wasrepeated(forthesecondtime)；atdl5theGroupAStreptococcusPreparationinjectionwasrepeated(forthesecondtime)・Thecyclesofcombinedmodalitytherapywereperformedwithanintervalof28days・Whetherthenextcycleoftherapyisneededdependsonthelocalchangesoflesionandvolumeoftheresidue・ResuItsMostcasesshowedimprovedappearanceofmaxillofacialdeformityandthatthelesionssignificantlyregressedafter2cyclesoftherapyweregiven.After3-4cyclesoftherapy,mostofcaseswerecuredwithalmostcompletelyregressedlesions・ConclusionTheinjectionintolesionwithcombinationofGroupAStreptococcusPreparationandbleomycina5isasafeandeffectivemethodforthetreatmentofhugelymphoheman^ionidofmaxillofacialregion,andcanimproveappearanceofmaxillofacialdeformityobviouslyinaffectedcases・Keywords:vascularma1formation；oralandmaxillofacial；infantsandchildren2006年1月〜2011年5月，笔者采用平阳霉素及A群链球菌溶液结合间隔腔内注射的方法，治疗颌面及舌部巨大淋巴管畸形合并血管畸形患者22例，取得了满意疗效，现报道如下。1临床资料本组22例患者，其中男12例，女10例，年龄4〜26个月，平均为13个月。腮区静脉畸形合并下颌下巨大淋巴管畸形9例，舌部静脉畸形合并下颌下巨大淋巴管畸形8例,颖部静脉畸形合并颌面颈部淋巴管畸形2例，颌面颈部淋巴管畸形合并静脉畸形3例。3例重度患儿入院时因舌部静脉畸形严重而无法将舌缩回口腔，无法正常发音，睡眠时呼吸困难。2治疗方法患者入院后化验血常规及肝、肾功能，并行胸部X线摄片，以上检查无异常者进行注射治疗。作B超或MR检查，了解病变大小、形态及与周围组织的关系。告知及皮试后，根据病变大小使用2〜8mg平阳霉素，加入地塞米松5mg,利多卡因10〜20mg,加入约10〜20ml生理盐水稀释。根据B超提示位置，进行静脉畸形穿刺注射，第一次抽回血后注入,根据大小掌握注入量。先用空注射器抽出淋巴管畸形囊液后，再将抽好的平阳霉素注入囊腔。注射后观察体...