Hemangioma is a common soft tissue tumor, which consists of a large number of proliferating blood vessels. Blood vessels and lymphatic vessels belong to the same source. In the early embryo, primitive blood vessel is a kind of tube composed of endothelial cells, forming a dense network in the middle of the matrix. Later, with the development of various organs, the original vascular network gradually differentiated into many vascular plexus and lymphatic plexus connected with organs. Although the final formation process of the peripheral circulation system is not clear, according to the experimental results, it is certain that it is closely related to the flow rate and pressure in the container. In the primitive stage, there is no difference in the structure of arteries, veins and lymphatic vessels, and only later will there be blood supply vessels (arteries), drainage vessels (veins) and lymphatic vessels. Muscle fibers in the middle layer of blood vessels and connective tissue in the adventitia are developed from the matrix around primitive endothelial cells. In the process of differentiation, any abnormality of the above tissues can form tumors, and hemangioma or (and) lymphangioma can appear. During the embryonic development of blood vessels, they can be distributed in three stages: clumping stage, reticular stage and dry stage. If there are obstacles or abnormalities in the normal development of a certain stage, the normal development of that stage will also be abnormal.
Treatment: ① surgical resection; ② Cryotherapy; ③ Radiotherapy and isotope therapy; ④ sclerotherapy; ⑤ Laser therapy; ⑥ Treating hemangioma with copper needle. 1. surgical treatment: surgical removal of diseased tissue to achieve the purpose of treatment. It has a good effect on independent small lesions. Under normal circumstances, the damaged area is rich in blood vessels and large in blood volume, which often leads to severe hemorrhagic shock. It is difficult and dangerous to need a lot of whole blood during the operation. At the same time, because the bleeding can not be completely removed, the operation was forced to terminate, and the postoperative recurrence rate was very high. Local deformity, loss and dysfunction of residual tumor after partial tumor resection. Surgery is expensive and the patient can't afford it. Facial cutaneous capillary hemangioma can be combined with cosmetic skin transplantation to repair the damaged area. Therefore, surgical treatment should strictly grasp the indications and weigh the surgical value before deciding whether to choose surgical treatment.
2. Cryotherapy: This method of treating hemangioma originated in 1960s (superficial small lesions can be used as appropriate). The operator uses the strong low temperature (-96℃) generated by the volatilization of liquid nitrogen, which is usually lower than -20℃, to coagulate the skin of the lesion area, hemangioma and the tissues around the hemangioma, so as to form ice crystals in its cells, leading to cell rupture, disintegration and death, and then the hemangioma disappears through the process of body repair. However, this method will leave scars locally, often leaving serious defects and dysfunction in the eyes, corners of the mouth, nose tip, ears and other parts after treatment. Because the intensity and depth of freezing operation are difficult to control and the resistance of tissues to low temperature is different, the treatment is not complete. The high recurrence rate directly affects the evaluation of curative effect. In addition, the dysfunction of local scar defect deformity is not the expected result of patients, but if this does not happen, the treatment is often ineffective.
3. Radiotherapy and isotope therapy: The principle of treatment is to bombard the nuclei of diseased tissues with gamma rays generated by radioactive elements, so as to break the DNA and RNA chains, stop the synthesis of nucleoprotein and cause cell death and disintegration, and then achieve the therapeutic purpose through the process of tissue repair. Commonly used in clinic are: shallow X-ray irradiation, cobalt 60 local irradiation, strontium 40 film sticking, phosphorus 32 colloid local injection and so on. After treatment, atrophic scar was left at the treatment site after radiation injury, and the epidermis fell off. For this atrophic tissue and atrophic scar caused by radiation exposure, experts suggest surgical resection, otherwise the possibility of canceration cannot be ruled out. Experts believe that the treatment of hemangioma should try to avoid radiotherapy.
4. Injection therapy of sclerosing agent: This method originated from injection therapy of hemorrhoids in 1950s. Its principle is: inject the sclerosing substance into the tumor tissue of hemangioma (not the blood vessel), causing aseptic inflammation, and after the swelling disappears, local fibrosis will occur, which will shrink or block the hemangioma and vascular cavity. Commonly used drugs are: ① sodium morrhuate; ② Kuzhiling injection; ③ Alum injection; (4) dried alum and coptis root injection; ⑤ Sodium bicarbonate injection; ⑥ Pingyangmycin and Bleomycin; ⑦ boiling water injection therapy; 8 urea injection.
5. Laser treatment: professional laser treatment equipment is used to coagulate hemangioma tissue to achieve the purpose of treating hemangioma. However, the depth of laser treatment is generally controlled within 0.2 ~ 0.4mm of superficial skin. If it exceeds 0.4mm, obvious scars will be produced, so it has a certain effect on superficial capillary hemangioma, and it is easy to cause bleeding and scar deformity for deep hemangioma.
Another photosensitive laser therapy (also known as photodynamic laser therapy) is to inject photosensitizer into the patient's blood vessels first, and then irradiate the hemangioma area with black light or long-wave laser. After the photosensitizer is activated, it produces a photochemical reaction, which leads to a photochemical process in the intima and stroma of hemangioma, blocking the vascular lumen and achieving the purpose of treatment. However, this treatment must be strict in the course of treatment, otherwise there will be serious photosensitive endophthalmitis and photosensitive retinitis after fibrous tissue disease. 、
6. Interventional therapy: under the guidance of "X", the arteriovenous catheter is introduced into the hemangioma, and then the embolic agent is injected into the tumor to produce aseptic inflammation, so as to achieve the effect of blocking the tumor blood vessels. Commonly used for visceral hemangioma such as hepatic hemangioma. For deep hemangioma of trunk and limbs, it is often difficult to achieve the expected effect due to the limitation of injection dose, dosage form and hemangioma characteristics. Strictly grasp the indications to prevent embolic agents from flowing into other organs and tissues.