| Backgroud:Hemangiomas are benign tumors that develop due to rapid growth of the endothelial cells that line blood vessels.Although hemangiomas can appear on any part of the body,they usually appear on the skin such as the head or neck area,particularly on the eyelid,upper lip and cheeks.Skin hemangiomas can be divided into three types according to the depth of their locations:superficial hemangioma located in the papillary dermis,deep hemangioma located inthe reticular dermis and subcutaneous tissue,and mixed hemangioma,which is a mixture of superficial and deep components.Skin hemangioma can cause aesthetic changes and psychosocial impact because they can cause major complications such as local infection,dysfunction or deformity,ulcerations and bleedings.At present,there are many kinds of the treatments of dermal skin hemangioma including laser treatment,cryotherapy,radiation and radionuclide therapy,local injection hardening agent,photodynamic therapy,hormone therapy and surgical treatment,.Laser therapy and oral administration of propranolol are the most common and safety treatment.How to accurately diagnose and select the appropriate treatment is the key and difficult point in the clinical treatment of hemangioma.Color Doppler ultrasound can observe the range and boundary of the lesion,distinguish the nature of the mass,at the same time to understand the internal echo and peripheral relations,and further show the distribution of vascular tissue.It is suggested that the main blood vessels and vascular malformations of the source and infiltration range.The pulse technique can measure peak arterial systolic flow velocity,resistance index,pulsatility index and other related blood flow parameters,to differentiate the arteries from veins,while observing the blood supply to the tumor and its relationship with peripheral blood vessels.Color Doppler ultrasound has guiding significance for determining the type of hemangioma,choicing of treatment and prognosis evaluation.At present,the effect of Color Doppler ultrasonography in the diagnosis of hemangioma is well-known,but it rarely be applied to the study of skin hemangioma treatment.How to use color Doppler ultrasound technology for hemangioma ultrasound characteristics and individual differences,and provide individual effective reference and application of color Doppler ultrasound in evaluation of vascular tumor treatment for hemangioma,is the main purpose of this paper.Method:199 cases of patients with cutaneous hemangiomas diagnosed in Nanjing children's Hospital and Jiangsu Province People's Hospital from January 2014 to December 2016 were collected.Age:45 days-6 years old;male 86,female 113.1.Color Doppler ultrasound was used to observe the extent of hemangioma infiltration,the nature of the tumor,measuring PSV and other related blood flow parameters,while understanding the ultrasound characteristics of various types of skin hemangioma.2.169 patients were randomly assigned to group A and group B according to the date of treatment.Group A was divided into three groups under color Doppler ultrasonography:GroupA-1(depth of skin hemangioma<1.2 mm)was treated with Intense Pulsed Light(IPL);Group A-2(depth of skin hemangioma 1.2-3mm)selected single pulse long pulse width 1064nmNd:YAG laser;groupA-3(depth of skin hemangioma 3?5mm or PSV>15cm/s)was dealed with IPL and single pulse long pulse width 1064nmNd:YAG laser.Group B was treated with single pulse long pulse width 1064nmNd:YAG laser without color Doppler ultrasound examination but with clinical experience.Two groups were evaluated the efficacy and safety after 5 times treatments.3.30 cases of deep hemangioma and mixed skin hemangioma for propranolol oral drug therapy(1-2mg/kg),color Doppler ultrasound was used to detect the changes of skin hemangioma volume,PSV,RI and elastic index in two children with hemangioma,and to compare the differences between the two groups before taking medication,1 month after taking medication and 3 months after taking medication.Result:1.Color Doppler ultrasound features of cutaneous hemangiomaColor Doppler ultrasound features of cutaneous hemangioma:this article collected 104 cases of infantile skin hemangioma in children,a total of 120 lesions.Including superficial skin hemangioma 90,mixed skin hemangioma 19,deep skin hemangioma 11,Shallow PSV of 4.6?47cm/s,an average of 15.39±10.82 cm/s,23 cases of skin hemangioma is not detected and blood flow signals.Mixed type and deep type of hemangioma volume size 2.79~22.18cm3,an average of 6.97±3.89 cm3.PSV was 37.9?89.7cm/s,with an average of 66.88±15.03 cm/s.RI was 0.39 to 0.94,with an average of 0.60±0.13.Skin hemangioma tumor elasticity index results showed blue and blue-green-based,skin hemangioma elasticity imaging elasticity index 0-4 points,an average of 2.72±1.21 points.2.IPL,1064nmNd:YAG treatment of skin hemangioma clinical study under the guidance of Color Doppler UltrasoundThe effective rate of Group A-1(IPL)was 90.9%;Group A-2(single pulse long pulse width 1064nmNd:YAG laser treatment)was 88.9%;Group A-3(IPL combined with single pulse pulse Width of 1064nmNd:YAG laser treatment)was 90.6%.The total effective rate of group A was 90%,while the control group of B group was 75.7%,there was significant difference between the groups(P<0.05).The incidence of adverse events was blistering(group A 20%;group B 21.9%),infection(group A 1.1%,group B 3.03%),Pigment change(group A 48.9%,group B 60.6%),scar(group A 16.7%,group B 26.5%).The incidence of infection,pigment change and scar adverse reaction in group A was significantly lower than that in group B(p<0.05).3.Evaluation of the efficacy of propranolol in the treatment of skin hemangioma by color Doppler ultrasonographySkin hemangioma volume change(6.97±3.89 cm3)before medication,(4.28±2.79cm3)1 month after taking medication,decline rate of 39%;(2.83±1.97cm3)3 months after taking medication decline rate of 58%.compared with 1 month after treatment(p<0.05),There was a significant difference between the two groups after 3 months of treatment(p<0.05).PSV was(66.88±15.03)cm/s before treatment,(52.46±11.21)cm/s after 1 month,decline rate of 21%;(38.11±10.64)cm/s after 3 months,decline rate of 43%,compared with 1 month after treatment(p<0.05),and there was a significant difference after 3 months of treatment(p<0.05)after 1 month of treatment.RI was(0.60+0.13)before treatment,(0.74±0.12)after 1 month of treatment the rising rate of23%,(0.85±0.12)after 3 months of treatment,the rising rate was 40%.There was also a significant difference between the two groups,before treatment compared with 1 month after treatment(p<0.05),1 month after treatment compared with 3 months after treatment(p<0.05).The pre-treatment elasticity score was 2.72± 1.21,2.82±1.07 after 1 month of treatment,2.93±0.81 after 3 months of treatment.There was no significant difference between the two groups,before treatment compared with 1 month after treatment(p>0.05)1 month after treatment compared with 3 months after treatment(p>0.05).Conclusion:1.Color Doppler ultrasound can observe the type of skin hemangioma,showing different imaging features of the skin hemangioma.2.The rational use of optoelectronic technology to treat skin hemangioma,can achieve efficacy,reducing a variety of adverse reactions under the guidance of color Doppler ultrasound.3.In the propranolol group,the volume and the PSV of the hemangioma were significantly decreased after treatment,while RI was significantly increased,but the elasticity index did not change.It is also confirmed that propranolol is an effective method for the treatment of cutaneous hemangiomas. |
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