How to treat hemangioma

The treatment of hemangioma needs to be decided according to different types and conditions. Treatment methods include drug therapy, surgical resection, laser therapy and local injection therapy. Some hemangiomas do not grow next to important anatomical structures, and the scope of hemangioma is very small, which can also be observed temporarily.

First, general treatment.

1. If patients with hemangioma have decreased platelets and hemoglobin, it is necessary to control the infection and avoid Kassabah-Mei Lite phenomenon.

2, preoperative or acute bleeding, can consider the input of blood products such as platelets, generally not as routine treatment.

Second, medication.

1, topical drugs:

(1) beta blockers, such as propranolol ointment, timolol cream, timolol eye drops, catolol eye drops, etc. Suitable for superficial infantile hemangioma. In addition to allergic contact dermatitis, there may be local redness, desquamation and other adverse reactions, such as bronchial asthma, severe or acute heart failure, sinus bradycardia, hypotension, II ~ III degree atrioventricular conduction, etc.

(2) 5% imiquimod, the common skin reactions are erythema, erosion, ulcer and scab. When there are adverse reactions, stop taking the medicine in time and continue taking the medicine after the skin recovers. Because the drug is easy to cause strong immune response in the skin, leading to skin texture changes and even scar formation in the later stage, it is recommended to use it with caution, including children with contraindications to external use of β -blockers.

2, local injection therapy:

(1) Glucocorticoid injection: mainly suitable for early, localized, deep or obviously thickened hemangioma. Patients with skin or hemangioma infection or systemic infection at the injection site are prohibited.

(2) Injection of anti-tumor drugs such as bleomycin and Pingyangmycin: When oral or local injection of glucocorticoid is ineffective, it is recommended to keep intravenous infusion unobstructed in order to prevent accidental allergy. Pingyangmycin is prohibited for those who are allergic to this drug, or accompanied by chickenpox, or whose white blood cell count is lower than 2.5 * 10 9/L, and for those who are allergic to Pingyangmycin antibiotics, it should be used with caution for those with liver, kidney and lung dysfunction.

3, oral medication:

(1) Propranolol: Pay attention to the indications when using this medicine. Before using this drug, children should be given a comprehensive physical examination, including myocardial enzymes, blood sugar, liver and kidney function, electrocardiogram, color Doppler echocardiography, thyroid function and so on. Regular follow-up visits should be made during medication, and biochemical, electrocardiogram, cardiac color ultrasound and local B-ultrasound should be reviewed every time to evaluate adverse reactions and curative effects. In case of myocardial damage, cardiac function damage, wheezing, hypoglycemia, etc., symptomatic treatment or consultation by the corresponding department should be carried out. During this period, the dosage of propranolol should be reduced, and the drug should be stopped when the adverse reactions are serious.

(2) Glucocorticoid: This treatment can now be used in cases with systemic indications but not suitable for propranolol treatment. Temporary effects such as height, weight and blood pressure may occur during medication, which should be closely monitored and vaccination should be stopped during medication.

(3) Rapamycin: Rapamycin inhibits mTOR signaling pathway and plays an important role in cell proliferation. Small sample studies have found that oral rapamycin can improve complex vascular malformations, including Kaposi's hemangioendothelioma. In vitro, it was found that rapamycin can reduce the proliferation of hemangioma endothelial cells. The main adverse reactions of rapamycin include mucosal inflammation, hyperlipidemia, headache, hepatocyte toxicity and neutropenia. Because of its little clinical experience and potential toxicity, rapamycin is recommended for children with hemangioma who are ineffective in other treatments and affect their life or function. The blood drug concentration must be strictly controlled, and antibiotics should be used preventively to prevent serious and dangerous infections.

Third, surgical treatment.

The principle is not to advocate excessive surgical treatment, but in the case that non-surgical treatment can not effectively control the disease, surgical treatment, such as visual development, respiratory obstruction, abnormal appearance, bleeding, ulcers and other non-surgical treatment is not excluded. It is feasible to remove hyperplastic fibrous fat and excess skin tissue to restore anatomical state. For localized lesions, early complete resection can achieve the purpose of early treatment, and does not significantly affect the appearance, which is beneficial to the physical and mental development of children and the prognosis of the disease. The determination of the best operation time depends on the location, size and shape of the lesion (pedicled or not) and other factors.

Fourth, radiotherapy.

Radiotherapy can be used to treat benign or borderline hemangioma, which can prevent angiogenesis, block capillaries and make hemangioma subside. At the same time, radiotherapy can also reduce the probability of postoperative recurrence of malignant hemangioma and prolong the survival time of patients.

Verb (short for verb) chemotherapy

1. Chemotherapy is suitable for patients with malignant hemangioma. Commonly used chemotherapy drugs are gemcitabine, adriamycin and dacarbazine.

2. Epithelioid hemangioendothelioma can be combined with chemotherapy when necessary. Commonly used drugs are gemcitabine, cyclophosphamide and sorafenib.

Six, physical therapy

Local pulsed dye laser: usually 585nm or 595nm pulsed dye laser, it is often used to inhibit the proliferation of superficial infantile hemangioma, reduce the color of hemangioma or the telangiectatic erythema after the hemangioma ulcer subsides. The treatment plan has no lesion selectivity, and it cannot inhibit the growth of deep lesions without forming new skin damage.