혈관종 Hemangioma

고 위험성 영아 혈관종 최근 치료 High risik Infantile Hemangioma recent treatment

1. Oral  Propranolol 2-3 mg/kg,  2~3 divided,  for 6 months

This powerful medicine is the mainstay of medical treatment for hemangiomas, replacing steroids as the first line medical treatment for infantile hemangiomas. The goal is to slow down the growth of the lesion. Propranolol is a beta-receptor blocker – it’s effects in general are to decrease heart rate, decrease blood pressure, relieve anxiety and various other uses. However, for infantile hemangiomas it has been found to decrease the rate of proliferation and increase the rate of involution. The doses at which propranolol is used for hemangiomas is much lower than for other conditions – therefore the side effects are extremely rare. Propranolol is also available as Hemangeol (made by Pierre-Fabre Pharmaceuticals).It is the only FDA approved version of propranolol for the treatment of infants with infantile hemangioma. It is formulated specifically for this use.

Oral or systemic steroids are used for rapidly proliferating lesions in a cosmetically sensitive area or one causing functional impairment.

The rare lesions that are life-threatening or do not respond to propranolol are always treated with steroids and, occasionally, other medicines. Due to steroid side effects, the use of this medicine is carefully monitored.

Traditionally, lesions around the eye have been treated with these injections, although surgery is often a better option, in our opinion.

2. Laser  treatment

It is mainly used to treat hemangioma remaining after surgical treatment.수술 치료 후 남은 혈관종을 치료 할 때 주로 쓴다.

The goal of laser treatments is to completely remove the lesion, set the stage for further treatments, treat complications or treat the inevitable broken blood vessels (telangiectasias) left behind as a hemangioma involutes.

The pulsed dye laser (PDL) with a dynamic cooling device is the mainstay for treatment of the superficial vascular component of the hemangioma. It can be used to slow the proliferation, reduce the redness and set the stage for other treatments.

Multiple treatments are typically needed. Depending on the lesion, age of the child and location, the treatments may be done with or without anesthesia. The least traumatic and safest way is chosen for each patient. The PDL can be used to help heal hemangiomas that have ulcerated (the skin has broken open).This is particularly helpful for lesions in the diaper area.

The Nd:YAG laser is used for treating the deep component of hemangiomas involving the oral cavity, larynx (voice box) and occasionally the skin. This laser must be very carefully used by experienced physicians. The KTP laser is most commonly used for airway lesions.

Resurfacing lasers such as the CO2 and Erbium are used to help with scar revisions and improving the texture of the skin after involution. In children, these must be used very carefully.

Surgery

수술 치료는 가능한 연기하나 기도 차단이 있는 경우나 시야 장애가 있거나 괴양이 있는 경우는 수술 치료를 우선 한다. Surgery Surgical treatment can be postponed if possible, but if there is airway blockage, visual field disturbance, or ulceration, surgical treatment is given priority.

Along with lasers, surgery achieves high results in most of our patients. There are many misconceptions about operating on hemangiomas – the risk of hemorrhage in particular – that we are trying to educate physicians about.

Unfortunately, there are physicians on TV and through lectures, have scared families into believing that only a handful of surgeons are capable of doing these surgeries.

The truth is that many doctors haven’t learned or had the opportunity to educate themselves more about these procedures. The Hemangioma Foundation is committed to training doctors to successfully operate on these lesions so families will not have to travel such great distances for treatment. In general, children can be operated on successfully with a minimal amount of blood loss.

Similar to lasers, the goal of surgery is to remove the lesion completely set the stage for other treatments, or correct what is left after involution. Lesions are operable throughout proliferation or involution.

Timing is influenced by the child’s age and weight as well as the impact the hemangioma is having on function.

For example, a rapidly proliferating compound hemangioma of the upper eyelid that is beginning to impair vision may be removed at an earlier point than a deep hemangioma of the back which has begun to involute. Surgeries may be done in stages in certain cases in order to get the best cosmetic result. Scar revisions, in particular, need to be done judiciously in young patients.

Often a combination of treatment options are used. Superficial component of a compound hemangioma of the nasal tip may be treated with the PDL in preparation for surgery of the deep component. A deep hemangioma of the orbit that is pushing on the eyeball could be treated with steroids while the PDL is used for a separate superficial lesion in the same patient.

The Hemangioma Treatment Foundation is a 501(c)(3) nonprofit recognized by the IRS and all donations are tax deductible. © 2016, All Rights Reserved에서 퍼온 글

국소 Timolol 국부 도포로 치료도 한다.간장 혈관종이 있으면 초음파촬영으로 진단한다. It is also treated with topical application of Timolol. If hepatic hemangioma is present, it is diagnosed by ultrasonography.