| Objective Retrospective analysis of all soft-tissue hemangioma patients in our department in recent three years,To study the concept on interventional treatment,imaging and clinical manifestations of soft-tissue hemangioma.To observe the clinical efficacy and safety of oral drugs and different interventional treatment methods,To analysis the factors of recurrence and to explore the prognostic factors of the clinical efficacy of the treatment of large soft-tissue hemangioma in children.Methods To summary,induce and classify of 5865 cases of soft-tissue hemangioma in children in 2013.01-2016.04,and It is concluded 529 hospitalized patients that large soft-tissue hemangioma, According to the different interventional methods,this study was divided into four parts:(1) To study the clinical efficacy of oral propranolol combined with local sclerotherapy for the treatment of children's large soft-tissue hemangioma,to compare occurrence and prevention of complication:237 cases,age:?5m,size:5-10cm.Male:86 cases,female:151 cases.According to the time to be divided into two groups.Group of simple treatment:86 cases, Local sclerosis treatment,procedures:Under the DSA or B ultrasound guidance,multi-point puncture on the tumor,Pumping blood,the Lauromacrogol (liquid or foam) or Pingyangmycin sclerotherapy agent slowly injected into the tumor tissue.Group of combined treatment:151 patients, combined treatment (oral propranolol combined with local sclerotherapy).The relevant examination.To give Propranolol the second days when 24h long-term ECG is normal, the initial dose of 1.Omg/kg/d,The average treatment time was 5 to 6 months, with the treatment of sclerotherapy same the group of simple treatment:.(2) To study the clinical efficacy and complications of the treatment of the large soft-tissue hemangioma by injection of Lauromacrogol foam sclerosing agent with pingyangmycin or bleomycin quadruple sclerotherapy. A total of 192 cases were treated with local sclerotherapy,age:<5m,size:5-10cm.Male:68 cases, female:124 cases.According to the treatment time to be divided into two groups.71 cases of local Pingyangmycin or bleomycin quadruple sclerotherapy as Group of PYM,121 cases of local injection of Lauromacrogol (liquid or foam)as the Group of Lauromacrogol, the two groups of patients in the local treatment when oral propranolol.conventional,oral medication before the local treatment.Preoperative tumor site local disinfection of shop towels, percutaneous puncture to see blood after the preparation of hardener slowly injected into the tumor.1 can not subside, repeated treatment every 7-10d.(3) To study the clinical efficacy and analysis multifactor of the impact on the efficacy of Superselective endovascular embolization combined with local hardening treatment with large soft-tissue (high blood flow) hemangioma in children:85 cases of large soft-tissue hemangioma, age:> 5m,size:? 5cm.Male,39 cases, female 46 cases,According to the period of time be divided into two groups:Group of simple treatment:(33 cases):Superselective endovascular embolization,operation process:Under general anesthesia,using the Seldinger technique,using the femoral artery angiography and superselective to tumor supplying artery which angiography and PVA or gelatin sponge embolization,to observe the clinical efficacy,repeated angiography after embolization;Group of combined treatment (52 cases): (Superselective endovascular embolization combined with Local sclerotherapy),Operation process:endovascular embolization method same the group A, after the end of the embolization of local sclerosis treatment.To observe the complications of the two groups after 3 days, followed up for 3 m to 1.5 years.(4) To explore the clinical efficacy of hormone and interventional therapy (super-selective endovascular embolization treatment and local Pingyang mycin injection therapy)of Kasabach-Merritt syndrome(KMS)in infant:15 cases were diagnosed as KMS, improve the preoperative examinations. First, the clinical treatment of hormone shock therapy,and then according to the different size of the tumor by different interventional methods, and observe the clinical efficacy.Among them,5 cases with tumor diameter< 5cm, Using local treatment; 7 cases of tumor in 5-10cm, using superselective transcatheter arterial embolization;3 cases of tumor>10cm,combination therapy (superselective endovascular embolization and local Pingyang mycin injection).Results (1) 237 cases were followed up for 3 months to 1.5 years,Group of simple treatment::the total effective rate was 89.5%(77/86),the average course was 4.3 times.Group of combined treatment:the total effective rate was 96.7%(146/151), and the average course was 2.8 times. The cure rate of group of combined treatment (X2=13.35,P<0.05) and total effective rate (X2=5.045, P=0.025, P<0.05) is better than the group of simple treatment.In complications, the incidence of complications in the group of simple treatment was 38.4%, the incidence rate of complications in the group of combined treatment was 25.8%, and the incidence rate of complications in the group of combined treatment was lower than that in the group of simple treatment:(38.4%(33/86) vs 25.8%(39/151), X2=4.077, P=0.043, P< 0.05.(2) 192 cases were treated with local sclerosis successfully.Group of PYM:the total effective rate was 80.3%(57/71), and the average treatment was 3.8 times. Group of Lauromacrogol:the total effective rate was 93.4%(113/121), the total treatment course was 2.2 times. The total effective rate of group of Lauromacrogol was better than group of PYM.X2=7.576,,P=0.006, P< 0.05. In complications,the incidence of group of PYM was lower than the group of Lauromacrogol (25.4% (18/71) vs33.0%((41/121),) X2=1.679, P=0.195,P>0.05,and no serious complications such as allergic and pulmonary fibrosis.(3)85 cases of large hemangioma were treated with endovascular embolization or combination successfully.Group of simple treatment:the total effective was 75.8% (25/33),The average treatment was 2.8 times,Group of combined treatment:the total effective was 96.2%(50/52), the treatment of the average course:1.5 times.Two groups in the cure rate:X2=1.561, P=0.212, P>0.05. Group of combined treatment was better than the group of simple treatment in the total effective rate.X2=6.245,P=0.012,P<0.05.In complications,The group of simple treatment was slightly higher than the group of combined treatment of the incidence (36.4%(12/33) vs32.7%(17/52), X2=0.064, P=0.996, P> 0.05.The main factors influencing the effective of superselective endovascular embolization in the treatment in two groups as follows:? the source of arterial supply:a.a single source of 64 cases (75.3%), the total efficiency of 95.3%(61/64), the total cours?2 times:5 cases (5.9%); b.mixed source:21 cases (24.7%), the total efficiency of 66.7%(14/21), the total course?2 times:13 cases (15.3%); the single source was more than mixed source in the total cases.It was less than mixed sources in the total course?2 times. And the total effective rate of a single source is better than the mixed source, X2=0.688, P=0.008, P < 0.05.? The number of arteries supply:a.1 of 3 cases (3.5%), the total efficiency of 100%(3/3); b.2,27 (31.8%), the total efficiency of 92.6%(25/27); c?3,55 (64.7%), the total efficiency of 85.5%(47/55). conclusion:the number of cases:?3> 2> 1,?2 times:?3> 2> 1, the total effective rate:1> 2>?3, X2=1.944, P=0.004,P< 0.05.(4) 15 cases were treated successfully,13 cases were cured,2 cases were ineffective, the total effective rate was 86.7%(13/15). Among them,5 cases of local treatment after 2 to 7 courses to achieve the standard,the effective rate 100%(5/5).7 patients were cured by transarterial embolization after 1 to 3 courses,1 case for clinical symptoms increased to change other Methods.The effective rate was 85.7% (6/7); 3 cases were treated with combination,2 cases were cured,1 case was invalid,effective rate 66.7%(2/3). Individual children with diarrhea, loss of appetite, fever and other symptoms, symptomatic treatment 2-5d after improvement.Conclusion Aged?5m,Oral propranolol combined with local sclerotherapy in the effective rate is better than the local sclerotherapy significantly, in the selection and comparison of hardening agent, Lauromacrogol foam sclerosing agent is better than Pingyangmycin quadruple in the total effective rate, the total period is short;Age>5m, Superselection endovascular embolization combined with local hardening treatment of large soft-tissue hemangioma were better than simple endovascular embolization in effective rate,less complications, and treatment safety, small trauma. In infants with KMS,clinical hormone combined with intervention can improve the cure and effective rate significantly. |
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