Comprehensive Treatment Of Perineal Hemangiomas And Vascular Malformations

Objective:Vascular malformations (VM) and hemangiomas (HA) are very common vascular diseases, which can occur in any part of the body surface, but rare in perineum. Perineum is a very special region. Perineal hemangiomas and vascular malformations (such as port-wine stains, venous malformations, arteriovenous malformations, lymphatic malformations or mixed malformations) may present considerable problem for patients, such as anogenital, urethral and external genital abnormality. Spontaneous regression is a very important characteristic of hemangioma, so the treatment is mainly to prevent excessive growth and complications such as ulcerations. The treatment of vascular malformations is mainly symptomatic treatment. Complete cure is almost impossible if we do not take any measures, and it will recurrence very soon. The treatment of VM is varied, including laser therapy, propranolol treatment, hormone therapy, sclerotherapy, copper needle therapy, isotope therapy, interferon therapy, radiofrequency ablation treatment, operation and so on. Laser therapy, propranolol treatment, sclerotherapy and operation treatment have been the main technique for the treatment of hemangiomas and vascular malformations. But laser treatment and surgery have certain limitations, propranolol can be only used for the treatment of hemangiomas. For sclerotherapy, we must pay more attention to the drug doses. Excessive use of these drugs may cause atrophy of adjacent organs, which may cause great impact on their individual life. This study will focus on the the efficacy and safety of those treatment methods for perineal hemangiomas and vascular malformations, and provide some reference for the treatment of perineal hemangiomas and vascular malformations.Methods:Between September,2009and November,2012, at burn and plastic surgery of Shandong Provincial Hospital,45patients with perineal hemangiomas and vascular malformations were enrolled in the study. Include34cases of hemangiomas and11cases of vascular malformations. Among of them,18cases are male and27cases are female. They are between0.1and29years old with an average of3.9years old.10cases of perineal hemangioma patients are male,24are female. They are between0.1and8years old with an average of0.7years old. For patients of perineal vascular malformations,8cases are male. They are between0.2and29years old with an average of13.9years old.5cases of perineal hemangiomas with ulcerations were treated by propranolol therapy only.27cases of perineal hemangiomas without ulcerations are treated by laser therapy combined with propranolol therapy.2cases of perineal hemangiomas were treated by operation after sclerotherapy. All of the11cases of perineal vascular malformationgs were treated by sclerotherapy. We have two ways to use propranolol. Three kinds of drugs (Pingyangmycin, triamcinolone acetonide and lauromacrogol) were used in sclerotherapy. The dosage of drugs is determined by the size and location of the lesion and the age of the patients. The injection of the sclerosant may be repeated every4weeks. Therapeutic efficacy is established by evaluating the size of the lesion, physical examination and color-coded duplex sonography (CCDS) before and after treatment. Therapeutic safety assessment were established through complications occurred during the treatment and treatment interval.Results:A total of45cases were treated in our study. All of these45patients were followed up for3months to18months. All of them have marked decrease in size after trearment.2cases of perineal hemangioma recovered very well after operation, without recurrence, the curative effect were excellent. Among of the5patients of hemangiomas with ulcerations,3cases were excellent, good in2cases. Ulcerations healed well after treatment and the tumor was significantly reduced in size. Tumors were significantly diminished in patients of hemangiomas treated by laser and propranolol, in which21cases were excellent in curative effect and good in6cases.11patients with vascular malformation were treated by sclerotherapy, the tumor become smaller and more flattened. Patients and their families were satisfied with the treatment. The result is excellent in5cases, good in5cases and fair in1patient. No failure case. No recurrence. All the symptoms of the patients were obviously improved.1case had ulceration and1case appear pigmentation after treatment. No serious complications. No major complications such as anaphylactic shock happened.Conclusions:1, Perineal hemangioma for which the type of growth and its size are limited, it is better to use sclerotherapy to make the tumor get smaller and reduce its blood supply before surgical excision.2, For the patients of perineal hemangiomas with ulcerations, propranolol therapy is very useful.3, The effect of laser treatment combined with propranolol therapy in the treatment of perineal hemangiomas were satisfied. Because of the effective treatment depth of laser and propranolol ointment is limited, for patients with active growth or deep perineal hemangioma, the effect of oral propranolol is very good.4, As a kind of sclerotherapy, pingyangmycin, triamcinolone acetonide and Lauromacrogol is a safe and effective method for the treatment of patient with perineal vascular malformations. No anaphylaxis or any drug-related complications occurred. But we must pay much more attention to the dosage of these drugs.