Nd：YAG激光治疗皮肤血管瘤的临床疗效分析
摘要
目的
回顾性分析应用Nd:YAG激光治疗的皮肤血管瘤病例,并复习有关国内外文献资料,探讨激光对皮肤血管瘤的治疗效果,影响治疗效果的因素,适应症的选择及并发症的防治。
方法
收集1999年8月～2006年6月间在广西医科大学第一附属医院整形美容外科采用532nm Nd:YAG激光治疗的皮肤血管瘤共546例,其中资料完整、随访超过6个月以上的患者501例,共552处病变。
根据病变条件先选择较小激光能量密度进行试打,确定参数后进行激光治疗。术后病变处常规冰敷15-30分钟。外敷紫花烧伤膏和金霉素眼膏至创面干燥、结痂。2-3个月后可进行第二次治疗。门诊定期随访观察,最短6个月,最长达6年。
判断疗效的标准:痊愈:病变及其表面颜色完全消退或消退≥90%,皮肤颜色、质地恢复正常,经6个月以上的随访无复发;显效:病变消退达60%～89%,皮肤颜色、质地基本恢复正常,无并发症发生,经6个月以上的随访无复发;有效:病变及其表面颜色消退达30%～59%,可有色素沉着,无疤痕形成及色素缺失;无效:病变及其表面颜色无变化或消退＜30%,或有色素缺失,或有浅表疤痕形成。
结果
1.激光治疗后近期观察激光治疗后病变创面均有不同程度的水肿,一般24-48小时达高峰,72小时左右创面干燥、结痂,7-14天结痂自然脱落。3个月内病变处避免日晒,一般无色素沉着。
2.临床疗效及影响因素血管瘤总治愈率为60.9%,总有效率为:86.2%;浅层皮肤血管瘤和深层皮肤血管瘤的治愈率分别为:67.4%、40.2%,有效率分别为:89.5%、75.8%。单纯激光治疗的血管瘤治愈率为56.0%,经平阳霉素和地塞米松局部注射或口服强的松与激光联合治疗(联合治疗)的血管瘤治愈率为70.4%。统计学分析结果表明:在Nd:YAG激光治疗的血管瘤病例中,浅层皮肤血管瘤和联合方法的治疗效果分别优于深层皮肤血管瘤和单纯激光的治疗效果(回归系数分别为1.209、-0.818,OR值分别为3.350、0.441,P值均＜0.01)。同时显示,在一定范围内,病变的面积越大,治疗效果越差;激光的能量密度越高、治疗的次数越多、治疗效果越好(方程系数分别为0.265、-0.071、-0.160,优势比分别为1.303、0.931、0.852,P值均＜0.05)。
3.不良反应本组552处病变中,15处出现表浅性疤痕(2.7%),16处出现色素沉着(2.9%);12处出现色素缺失(2.2%);未见溃疡形成等其它不良反应及意外损伤。
结论
1.Nd:YAG激光治疗皮肤血管瘤是一种安全、有效的治疗方法。能在符合美容要求的前提下,较大程度地控制血管瘤的生长,促进其消退,特别适用于颜面四肢等暴露部位。
2.Nd:YAG激光对皮肤血管瘤的治疗效果与激光参数选择及病变条件有关,在临床治疗过程中,通过对激光参数的调整和加强血管瘤激光治疗适应症的选择,可提高血管瘤的治愈率。
3.激光的穿透能力有限,对于位置深、面积大的皮肤血管瘤根据具体情况与其它方法如平阳霉素加地塞米松局部注射、激素口服等联合治疗,可以提高皮肤血管瘤的治愈率,减少并发症的发生。
4.Nd:YAG激光有导致色素沉着、色素缺失、疤痕形成的风险,可能与病人的肤色、体质及激光能量密度过高和治疗后创面的护理不当等因素有关,治疗过程中应加以注意。
OBJECTIVE
The study aims at observing the therapeutic efficacy of the cutaneous hemangiomas, the influencing factors of the effects, the choice of the indication and the prevention of the adverse effects by the retrospective analysis of the cases treated with 532nm Nd:YAG laser and the review of the relevant data.
METHOD
Between August 1999 and June 2006, the 546 cases with hemangiomas were treated with 532nm Nd:YAG laser in department of plastic and aesthetic, the first affiliated hospital of Guangxi medical university. A total 501 cases(552 lesions) were followed up over 6 months and have integrity dada among the 546 cases.
At first, we should tentatively treat with the lower parameters of laser on the basis of the conditions of tumors and then cure the lesions in the decided parameters. The lesions were usually covered with ice about 15-30 minutes after treament and were overlaid in burn cream and oculentum aureomycini every day to form an incrustation. The next treatment might be carried out after 2-3 months. All the patients were followed up for 0.5-6 years.
The judgment of the therapeutic effects: cure: the tumors disappeared completely or≥90%, the color and texture of the skin recovered completely, there were not recurrence by being followed up; obvious effects: the tumors extinguished 60%-89%, the color and texture of the skin recovered visibly without recurrence by being followed up, there were not any complications; ordinary effects: the tumors and the color of the skin extinguished 30%-59%, the skin of the lesions might have slight chromatosis, but there were not scaring and absence of pigment; inefficacy: the tumors had no amelioration or extinguished < 30%, or the complications, such as absence of serious pigment or obvious scaring et al, had taken place.
RESULTS
1. Recent Observation The lesions had a different extent hydroncus that would go to a peak about 24-48 hours, and the crustas would be formed in 72 hours and would be off between 7-14 days after treatment. The skin of lesions had not usually chromatosis without being exposed to sun in 3 months.
2. Clinical Effects and Influencing Factors The cure rate of the total cases, the hemangiomas in superficial and deep-seated skin were respectively 60.9%, 67.4% and 40. 2%, and the effective rate of them were 86. 2%, 89. 5%, 75. 7%; the cure rate of the hemangiomas , on laser and combined methods, were respectively 56.0% and 70. 4%. The analytic result of the statistics: the therapeutic effects of the superficial hemangiomas and the combined methods were more excellent than that of the deep-seated hemangiomas and the only laser treatment(B=1.209、-0.818, Exp(B)=3.350、0.441, Sig<0.01). The smaller size of hemandiomas, the higher energy of laser and the more therapeutic times, the therapeutic effects of hemangiomas were more excellent (B=0.265、-0.071、-0.160,Exp(B)=1.303、0.931、0.852, Sig<0.05).
3.Adverse Effect Among 552 lesions, 15 lesions had atrophic scar(2.7%) , 16 lesions present pigmentation(2.9%), 12 lesions appeared absence of pigment(2.2%), other complications, such as elcosis et al, did not take place.
CONCLUSION
1. It is a safe and active method to treat cutaneous hemangiomas with 532nm Nd:YAG laser. Since 532nm Nd:YAG laser can restrain effectually the growth of hemangiomas and facilitate its extinction on the premise that being in line with the aesthetics, it is particularly proper to treat the cutaneous hemangiomas in the exposed position.
2. Since the therapeutic effects of the cutaneous hemangiomas on 532nmNd:YAG laser were closely concerned with the parameters of the laser and the conditions of the lesions, the cure rate of the cutaneous hemangiomas can be improved by adjusting the parameters of the laser and selecting the correct cases.
3. Because the depth that laser can arrive is restrict, according to the conditions of the lesions, laser can be combined with other methods, such as local injection of pingyangmycin and Dexamethasone, taking prednisone et al, to raise the cure rate and decrease complications.
4. 532nm Nd:YAG laser has the risk of chromatosis, absence of pigment and scarring, which may be relational with many factors , such as the complexion and constitution of patients, the exorbitant energy density of laser and the unsuitable nursing of lesions et al; therefore, we must be cautious in the therapeutic progress.
回顾性分析应用Nd:YAG激光治疗的皮肤血管瘤病例,并复习有关国内外文献资料,探讨激光对皮肤血管瘤的治疗效果,影响治疗效果的因素,适应症的选择及并发症的防治。
方法
收集1999年8月～2006年6月间在广西医科大学第一附属医院整形美容外科采用532nm Nd:YAG激光治疗的皮肤血管瘤共546例,其中资料完整、随访超过6个月以上的患者501例,共552处病变。
根据病变条件先选择较小激光能量密度进行试打,确定参数后进行激光治疗。术后病变处常规冰敷15-30分钟。外敷紫花烧伤膏和金霉素眼膏至创面干燥、结痂。2-3个月后可进行第二次治疗。门诊定期随访观察,最短6个月,最长达6年。
判断疗效的标准:痊愈:病变及其表面颜色完全消退或消退≥90%,皮肤颜色、质地恢复正常,经6个月以上的随访无复发;显效:病变消退达60%～89%,皮肤颜色、质地基本恢复正常,无并发症发生,经6个月以上的随访无复发;有效:病变及其表面颜色消退达30%～59%,可有色素沉着,无疤痕形成及色素缺失;无效:病变及其表面颜色无变化或消退＜30%,或有色素缺失,或有浅表疤痕形成。
结果
1.激光治疗后近期观察激光治疗后病变创面均有不同程度的水肿,一般24-48小时达高峰,72小时左右创面干燥、结痂,7-14天结痂自然脱落。3个月内病变处避免日晒,一般无色素沉着。
2.临床疗效及影响因素血管瘤总治愈率为60.9%,总有效率为:86.2%;浅层皮肤血管瘤和深层皮肤血管瘤的治愈率分别为:67.4%、40.2%,有效率分别为:89.5%、75.8%。单纯激光治疗的血管瘤治愈率为56.0%,经平阳霉素和地塞米松局部注射或口服强的松与激光联合治疗(联合治疗)的血管瘤治愈率为70.4%。统计学分析结果表明:在Nd:YAG激光治疗的血管瘤病例中,浅层皮肤血管瘤和联合方法的治疗效果分别优于深层皮肤血管瘤和单纯激光的治疗效果(回归系数分别为1.209、-0.818,OR值分别为3.350、0.441,P值均＜0.01)。同时显示,在一定范围内,病变的面积越大,治疗效果越差;激光的能量密度越高、治疗的次数越多、治疗效果越好(方程系数分别为0.265、-0.071、-0.160,优势比分别为1.303、0.931、0.852,P值均＜0.05)。
3.不良反应本组552处病变中,15处出现表浅性疤痕(2.7%),16处出现色素沉着(2.9%);12处出现色素缺失(2.2%);未见溃疡形成等其它不良反应及意外损伤。
结论
1.Nd:YAG激光治疗皮肤血管瘤是一种安全、有效的治疗方法。能在符合美容要求的前提下,较大程度地控制血管瘤的生长,促进其消退,特别适用于颜面四肢等暴露部位。
2.Nd:YAG激光对皮肤血管瘤的治疗效果与激光参数选择及病变条件有关,在临床治疗过程中,通过对激光参数的调整和加强血管瘤激光治疗适应症的选择,可提高血管瘤的治愈率。
3.激光的穿透能力有限,对于位置深、面积大的皮肤血管瘤根据具体情况与其它方法如平阳霉素加地塞米松局部注射、激素口服等联合治疗,可以提高皮肤血管瘤的治愈率,减少并发症的发生。
4.Nd:YAG激光有导致色素沉着、色素缺失、疤痕形成的风险,可能与病人的肤色、体质及激光能量密度过高和治疗后创面的护理不当等因素有关,治疗过程中应加以注意。
OBJECTIVE
The study aims at observing the therapeutic efficacy of the cutaneous hemangiomas, the influencing factors of the effects, the choice of the indication and the prevention of the adverse effects by the retrospective analysis of the cases treated with 532nm Nd:YAG laser and the review of the relevant data.
METHOD
Between August 1999 and June 2006, the 546 cases with hemangiomas were treated with 532nm Nd:YAG laser in department of plastic and aesthetic, the first affiliated hospital of Guangxi medical university. A total 501 cases(552 lesions) were followed up over 6 months and have integrity dada among the 546 cases.
At first, we should tentatively treat with the lower parameters of laser on the basis of the conditions of tumors and then cure the lesions in the decided parameters. The lesions were usually covered with ice about 15-30 minutes after treament and were overlaid in burn cream and oculentum aureomycini every day to form an incrustation. The next treatment might be carried out after 2-3 months. All the patients were followed up for 0.5-6 years.
The judgment of the therapeutic effects: cure: the tumors disappeared completely or≥90%, the color and texture of the skin recovered completely, there were not recurrence by being followed up; obvious effects: the tumors extinguished 60%-89%, the color and texture of the skin recovered visibly without recurrence by being followed up, there were not any complications; ordinary effects: the tumors and the color of the skin extinguished 30%-59%, the skin of the lesions might have slight chromatosis, but there were not scaring and absence of pigment; inefficacy: the tumors had no amelioration or extinguished < 30%, or the complications, such as absence of serious pigment or obvious scaring et al, had taken place.
RESULTS
1. Recent Observation The lesions had a different extent hydroncus that would go to a peak about 24-48 hours, and the crustas would be formed in 72 hours and would be off between 7-14 days after treatment. The skin of lesions had not usually chromatosis without being exposed to sun in 3 months.
2. Clinical Effects and Influencing Factors The cure rate of the total cases, the hemangiomas in superficial and deep-seated skin were respectively 60.9%, 67.4% and 40. 2%, and the effective rate of them were 86. 2%, 89. 5%, 75. 7%; the cure rate of the hemangiomas , on laser and combined methods, were respectively 56.0% and 70. 4%. The analytic result of the statistics: the therapeutic effects of the superficial hemangiomas and the combined methods were more excellent than that of the deep-seated hemangiomas and the only laser treatment(B=1.209、-0.818, Exp(B)=3.350、0.441, Sig<0.01). The smaller size of hemandiomas, the higher energy of laser and the more therapeutic times, the therapeutic effects of hemangiomas were more excellent (B=0.265、-0.071、-0.160,Exp(B)=1.303、0.931、0.852, Sig<0.05).
3.Adverse Effect Among 552 lesions, 15 lesions had atrophic scar(2.7%) , 16 lesions present pigmentation(2.9%), 12 lesions appeared absence of pigment(2.2%), other complications, such as elcosis et al, did not take place.
CONCLUSION
1. It is a safe and active method to treat cutaneous hemangiomas with 532nm Nd:YAG laser. Since 532nm Nd:YAG laser can restrain effectually the growth of hemangiomas and facilitate its extinction on the premise that being in line with the aesthetics, it is particularly proper to treat the cutaneous hemangiomas in the exposed position.
2. Since the therapeutic effects of the cutaneous hemangiomas on 532nmNd:YAG laser were closely concerned with the parameters of the laser and the conditions of the lesions, the cure rate of the cutaneous hemangiomas can be improved by adjusting the parameters of the laser and selecting the correct cases.
3. Because the depth that laser can arrive is restrict, according to the conditions of the lesions, laser can be combined with other methods, such as local injection of pingyangmycin and Dexamethasone, taking prednisone et al, to raise the cure rate and decrease complications.
4. 532nm Nd:YAG laser has the risk of chromatosis, absence of pigment and scarring, which may be relational with many factors , such as the complexion and constitution of patients, the exorbitant energy density of laser and the unsuitable nursing of lesions et al; therefore, we must be cautious in the therapeutic progress.
引文
1.Cheung DS,Warman ML,Mulliken JB.Hemangioma in twins[J] .Ann Plast Surg, 1997, 38(3):269.
2. Brown TJ, Friendman J, Levy ML. The diagnosis and treatment of common birthmarks[J]. Clin Plast Surg, 1998, 25(4): 509.
3. MacCollum, D. W, Martin, L. W. Hemangiomas in infancy and childhood:A report based on 6479 cases[J]. Surg Clin North Am. 1956,36:1647.
4.Pack GT, Miller TR. Hemangiomas:Classification, diagnosis and treatment [J]. Angiology, 1950,1:405.
5. Beth A. Drolet, Nancy B. Esterly Hona J, et al . Hemangiomas in children[J].The new England J of Med. 1999, 341(13):173.
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7. Achauer BM, Chang CJ, Vander Kam VM. Management of hemangioma of infancy:review of 245 patients[J]. Plast Rrconstr Surg, 1997, 99(5) :1301.
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1.Cheung DS,Warman ML,Mulliken JB.Hemangioma in twins[7].Ann Plast Surg,1997,38(3):269.
2.Brown TJ,Friendman J,Levy ML.The diagnosis and treatment of common birthmarks[J].Clin Plast Surg,1998,25(4):509.
3.Macollum,D.W,Martin,L.W.Hemangiomas in infancy and childhood:A report based on 6479 cases[J].Surg Clin North Am.1956,36:1647.
4.Pack GT,Miller TR.Hemangiomas:Classification,diagnosis and treatment[5].Angiology,1950,1:405.
5.Beth A.Drolet,Nancy B.Esterly Hona J,et al.Hemangiomas in children[J].The new England J of Med.1999,341(13):173.
6.Boon LM,Enjolras O.Mulliken JB.Congenital hemangioma:evidence of accelerated involution[J].J Pediatr,1996,128(3)329.
7.Achauer BM,Chang CJ,Vander Kam VM.Management of hemangioma of infancy:review of 245 patients[J].Plast Rrconstr Surg,1997,99(5):1301.
8.Jackson IT,Carreno R,Potparic Z,et al.Hemangiomas,vascular malformations and lymphovenous malformations:classification and methods of treatment[J].Plast Reconstr Surg,1993,91(7):1216.
9.王玉琦,叶建荣主编.血管外科治疗学[M].第一版,上海科学技术出版社,2003.353。
10.Mulliken JB,Glowacki J.Hemangiomas and vascular malformations in infants and children:a classification based on endothelial characteristics[J].Plast Reconstr Surg,1982,69(3):412.
11.郑勤田,李恭才,顾建章等.血管瘤的组织学及超微结构研究[J].中 华小儿外科杂志,1990,11:7.
12.DrDlet BAo Esterly NB,Frieden IJ.Hemangiomas in childen[J].N Engl J Med,1999,341(3):173.
13.Yakes WF,Rossi P,Odink H.Arteriovenous malformation management.Cardiovasc Intervent Radiok[J].1996,19:65.
14.刘文英,张尚福,胡迁泽.小儿血管瘤与血管崎形组织中性激素受体的表达[J].中华外科杂志,1999,37(5):295。
15.Janobs JWG,Griep EN,Lems WF,et al.local muscle hypertrophy due to an arterio-venous malformation[J].Br J Rheumatol,1994,33:173.
16.Seccia A,Salgarillo M,Fardlo E,et al.Combined radiological and surgical treatment Of arteriovenous malformations of the head and neck[J].Ann Plast Surg.1999,431(4):359.
17.Anderson RR,Parish JA,Microvasculature can be selectively damaged using dye laser:a basic theory and experimental evidence in human skin[J].Lasers surg med,1983;1:263-267.
18.Herd RM,Dover JS,Arndt KA.Basic laser principles[J].Dermatol Clin.1997,15(3):355-372.
19.Tainzi EL,Lupton JR,Alster TS.Lasers in dermatology:four decades of progress[J].Am Acad Dermatol,2003,49:1-31.
20.Bailin PL.Treatmentof port-wine stains with the CO2 laser:Earlyresults in Arrdt KA,Noe JM Rosen S:Cutaneous Laser therapy:Principles and methods[J].New York,John wiley and Sons Inc.1983,129-136.
21.黄和平,胡琼华,易阳艳等.CO2激光治疗婴幼儿体表增殖性血管瘤[J].中国美容医学,2004,13(5):549-550。
22. 王淑香,于景芳.CO2激光治疗婴幼儿先天性血管瘤[J].激光杂志,2003, 24 (3) : 19,
23. Noe JM, Barsky SH, Geer DE, et al. Port wine stains and the response to argon laser therapy :successful treatment and the predictive role of color age, and biopsy [J].Plast Reconstr Surg ,1980,654:1306.
24. Finley JL, Healing of Port wine stains after argon laser therapy[J]. Arch Dermatol. 1981,117(8) :486 .
25.Achauer BM, Vander Kam VM.Vascular lesions[J].Clin Plast Surg, 1993,20:43.
26. Raulin C, Greve B. Retrospective clinical comparison of hemangioma treatment by flashlamp-pumped (585 nm) and frequency-doubled Nd: YAG(532 nm) lasers[J]. Lasers Surg Med, 2001, 28: 40-43.
27. Alster TS, Lupton JR. Lasers in dermatology. An overview of types and indications[J]. Am J Clin Dermatol. 2001,2: 291-303.
28. Holy A,Geronemus RG. Treatment of periorbital port-wine stains with the flashlamp-pumped pulsed dye laser[J]. Arch Ophthalmol, 1992, 110(6): 793.
29. Swinehart JM. Hypertrophic scarring resulting from flashlamp-pumped pulsed dye laser surgery[J].J Am Acad Dermatol, 1991,25:845.
30. Lou WW , Geronemus RG. Treatment of port-wine stains by variable pulse width pulsed dye laser with cryogen spray: a preliminary study[J]. Dermatol Surg, 2001. 27: 963—965.
31.Rothfleisch. JE, Kosann MK. Levine VJ , et al. laser treatment of congenital and acquired vascular lesions,A review[J].Dermatol Clin.2002,20:1-18.
32.蔡慧敏,张少渊,翁玲达等.595nm脉冲染料激光治疗皮肤血管性疾病临床分析[J].应用激光,2004,24[6]:418-419。
33.Reyes BA,Geronemus R.Treatment of port-wine stains during childhood with the falshlamp-pumped plused laser[J].Am Acad Dermatol,1990,23(6):1142-1148.
34.Dummer R.Graf P,Greif C,et al.Treatment of vascular lesions using the VemaPulse variable pulse width frequency doubled neodymium:YAG laser[J].Dermatology,1998,197:158-161.
35.赵恩兵,王黎,刘瑞红,等.Nd:YA G激光在小儿血管瘤治疗中的应用(附166例报告)[J].陕西医学杂志,2003,32(2):122-124.
36.Clark C,Cameron H,Moseley H,et al.Treatment of superficial cutaneous vascular lesions:experience with the KTP 532 nm laser[J].Lasers Med Sci,2004,19:1-5.
37.苑凯华,张超,廖元兴,等.不同波长激光治疗浅表性皮肤血管性疾病临床分析[J].中国激光医学杂志,2005,14(4):269.
38.陈小松.激光治疗鲜红斑痣351例临床疗效分析[J].福建医科大学学报.2005,39(1):89-90.
39.Finn MC,Glowacki J,Mulliken JB.Congenital vascular lesions:clinical application of a new classification[J].J Pedlar Surg,1983,18:894.
40.马丽,吴润达,金晓东,等.595 nm与585 nm激光治疗鲜红斑痣的疗效比较[J].临床皮肤科杂志,2003,32(3):168-169。
41.张劲松,李长根,方震.PhotoDerm VL/PL强脉冲激光治疗皮肤血管性疾病208例疗效分析[J].实用医学杂志,2004,20(6):661-662.
42.纪彦林,尹国胜,赵小忠等.脉冲激光治疗面部毛细血管扩张162例临床分析[J].临床皮肤科杂志,2001,30(4):243-244。
43.刘春利,高景恒.激光技术在整形美容外科的应用[J].实用美容整形外科杂志,2000,11(3):113。
44.Raulin C,Sehroeter CA,Weiss RA,et al.Treatment of port-wine stains with a noneoherent pulsed light source:a retrospective study[J].Arch Dermatol,1999,135(6):679-683.
45.陈天新,李芍华,王敏,等.595nm波长激光采用不同能量与脉宽对表浅血管的作用[J].中国临床康复,2004,32(8):7202-7203。
46.李志清 彭大文 赵蓉萍,等.三种波长激光联合治疗颌面部草莓状血管瘤[J].中国激光医学杂志,2006,15(3):170-172。
47.周国瑜,沈玲悦,田克斌,等.长脉冲可调脉宽Gentle YAG 1064nm激光治疗颌面部血管瘤113例效果评估[J].上海口腔医学,2006,15(3):150-153。
48.周展超,吴余乐.皮肤美容激光,第一版,南京;东南大学出版社,2000.9:50-51。
49.Muelller B U,Mull Iken JB.The infant with a vascular tumor[J].Semin Perinatol,1999,23(4):332-340.
50.Bartoshesky LE.Corticosteroid treatment of Cutaneous hemangiomas:how effective a report on 24 children[J].Clin Pediatr,1978,17:625.
51 苑凯华,刘春利,李勤等.VPW532nm波长激光与平阳霉素联合治疗小儿血管瘤[J].实用美容整形外科杂志,2000,11(6):306-308。
52.王肃生,梁 刚,张志华,等.平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤[J].中国实用美容整形外科杂志,2006,17(2):95-97。
53.谭志建 刘凌 童晓荣,等.激素加脉冲染料激光治疗皮肤血管瘤疗效研 究[J].中华物理医学与康复杂志,2003,25(7):445-446。
54.李志清,尹明平,赵蓉萍,等.Nd:YAG激光联合平阳霉素治疗口腔血管瘤[J].中国激光医学杂志,2002,11(2):96-98。
55.邓波,谢红付,肖满兰.脉冲染料激光联合曲安奈德局部注射治疗小儿混合型皮肤血管瘤[J].临床皮肤科杂志.2003,32(7):418-419。
56.Seukeran DC,Collins P,Sheehan Dare RA.Adverse reactions of port wine stains in 701 patients[J].Br J Dermatol,1997,136:725-729.
57.吕蓉,潘福琼,常有军,等.585nm脉冲染料激光治疗皮肤血管异常性疾病的副作用及相关因素分析[J].中国激光医学杂志2004,13(2):101-104。
58.Livine VJ.The side effects of 577-585nm pulse dye laser treating vascular abnormalities in 500 cases[J].J AM Acard Dermatol,1995,32:613-617.
2. Brown TJ, Friendman J, Levy ML. The diagnosis and treatment of common birthmarks[J]. Clin Plast Surg, 1998, 25(4): 509.
3. MacCollum, D. W, Martin, L. W. Hemangiomas in infancy and childhood:A report based on 6479 cases[J]. Surg Clin North Am. 1956,36:1647.
4.Pack GT, Miller TR. Hemangiomas:Classification, diagnosis and treatment [J]. Angiology, 1950,1:405.
5. Beth A. Drolet, Nancy B. Esterly Hona J, et al . Hemangiomas in children[J].The new England J of Med. 1999, 341(13):173.
6.Boon LM, Enjolras O. Mulliken JB. Congenital hemangioma:evidence of accelerated involution[J]. J Pediatr, 1996,128(3)329.
7. Achauer BM, Chang CJ, Vander Kam VM. Management of hemangioma of infancy:review of 245 patients[J]. Plast Rrconstr Surg, 1997, 99(5) :1301.
8. Jackson IT, Carreno R, Potparic Z, et al. Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment[J]. Plast Reconstr Surg, 1993, 91(7): 1216-1230.
9. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics [J]. Plast Reconstr Surg, 1982, 69(3):412.
10.Yakes WF,Rossi P,Odink H.Arteriovenous malformation management.Cardiovasc Intervent Radiok[J].1996,19:65.
11.刘文英,张尚福,胡迁泽.小儿血管瘤与血管崎形组织中性激素受体的表达[J].中华外科杂志,1999,37(5):295。
12.周展超,吴余乐.皮肤美容激光,第一版,南京;东南大学出版社,2000.9:46-50。
13.Anderson RR,Parish JA,Microvasculature can be selectively damaged using dye laser:a basic theory and experimental evidence in human skin[J].Lasers surg med,1983;1:263-267.
14.Herd RM,Dover JS,Arndt KA.Basic laser principles[J].Dermatol Clin.1997,15(3):355-372.
15.mainzi EL,Lupton JR,Alster TS.Lasers in dermatology:four decades of progress[J].Am Acad Dermatol,2003,49:1-31.
16.谭志建 刘凌 童晓荣等.激素加脉冲染料激光治疗皮肤血管瘤疗效研究[J].中华物理医学与康复杂志,2003,25(7):445-446。
17.吕蓉,潘福琼,常有军,等.585nm脉冲染料激光治疗皮肤血管异常性疾病的副作用及相关因素分析[J].中国激光医学杂志,2004,13(2):101-104。
18.纪彦林,尹国胜,赵小忠等.脉冲激光治疗面部毛细血管扩张162例临床分析[J].临床皮肤科杂志,2001,30(4):243-244。
19.刘春利,高景恒.激光技术在整形美容外科的应用[J].实用美容整形外科杂志,2000,11(3):113。
20.陈天新,李芍华,王敏,等.595nm波长激光采用不同能量密度与脉宽对表浅血管的作用[J].中国临床康复,2004,32(8):7202-7203。
21.周国瑜,张志愿,李江.52例鲜红斑痣颜色类别的病理图像计算机分析[J].口腔颌面外科杂志,1999;9(2):112-115。
22.周国瑜,沈玲悦,田克斌,等.长脉冲可调脉宽Gentle YAG 1064nm 激光治疗颌面部血管瘤113例效果评估[J].上海口腔医学,2006,15(3):150-153。
23.Herd RM,Dover JS,Arndt KA.Basic laser principles[J].Dermatol Clin.1997,15(3):355-372.
24.王肃生,梁 刚,张志华等.平阳霉素及糖皮质激素与激光联合治疗儿童颌面6部血管瘤[J].中国实用美容整形外科杂志,2006,17(2):95-97。
25.Muelller B U,Mull Iken JB.The infant with a vascular tumor[J].Semin Perinatol,1999,23(4):332-340.
26.林晓曦,王炜,曹谊林.血管瘤和血管畸形治疗中的美容原则探讨[J].中华医学美容美学杂志,2003,9:190-192。
27.Livine VJ,The side effects of 577-585nm pulse dye laser treating vascular abnormalities in 500 cases[J].J AM Acard Dermatol,1995,32:613-617.
1.Cheung DS,Warman ML,Mulliken JB.Hemangioma in twins[7].Ann Plast Surg,1997,38(3):269.
2.Brown TJ,Friendman J,Levy ML.The diagnosis and treatment of common birthmarks[J].Clin Plast Surg,1998,25(4):509.
3.Macollum,D.W,Martin,L.W.Hemangiomas in infancy and childhood:A report based on 6479 cases[J].Surg Clin North Am.1956,36:1647.
4.Pack GT,Miller TR.Hemangiomas:Classification,diagnosis and treatment[5].Angiology,1950,1:405.
5.Beth A.Drolet,Nancy B.Esterly Hona J,et al.Hemangiomas in children[J].The new England J of Med.1999,341(13):173.
6.Boon LM,Enjolras O.Mulliken JB.Congenital hemangioma:evidence of accelerated involution[J].J Pediatr,1996,128(3)329.
7.Achauer BM,Chang CJ,Vander Kam VM.Management of hemangioma of infancy:review of 245 patients[J].Plast Rrconstr Surg,1997,99(5):1301.
8.Jackson IT,Carreno R,Potparic Z,et al.Hemangiomas,vascular malformations and lymphovenous malformations:classification and methods of treatment[J].Plast Reconstr Surg,1993,91(7):1216.
9.王玉琦,叶建荣主编.血管外科治疗学[M].第一版,上海科学技术出版社,2003.353。
10.Mulliken JB,Glowacki J.Hemangiomas and vascular malformations in infants and children:a classification based on endothelial characteristics[J].Plast Reconstr Surg,1982,69(3):412.
11.郑勤田,李恭才,顾建章等.血管瘤的组织学及超微结构研究[J].中 华小儿外科杂志,1990,11:7.
12.DrDlet BAo Esterly NB,Frieden IJ.Hemangiomas in childen[J].N Engl J Med,1999,341(3):173.
13.Yakes WF,Rossi P,Odink H.Arteriovenous malformation management.Cardiovasc Intervent Radiok[J].1996,19:65.
14.刘文英,张尚福,胡迁泽.小儿血管瘤与血管崎形组织中性激素受体的表达[J].中华外科杂志,1999,37(5):295。
15.Janobs JWG,Griep EN,Lems WF,et al.local muscle hypertrophy due to an arterio-venous malformation[J].Br J Rheumatol,1994,33:173.
16.Seccia A,Salgarillo M,Fardlo E,et al.Combined radiological and surgical treatment Of arteriovenous malformations of the head and neck[J].Ann Plast Surg.1999,431(4):359.
17.Anderson RR,Parish JA,Microvasculature can be selectively damaged using dye laser:a basic theory and experimental evidence in human skin[J].Lasers surg med,1983;1:263-267.
18.Herd RM,Dover JS,Arndt KA.Basic laser principles[J].Dermatol Clin.1997,15(3):355-372.
19.Tainzi EL,Lupton JR,Alster TS.Lasers in dermatology:four decades of progress[J].Am Acad Dermatol,2003,49:1-31.
20.Bailin PL.Treatmentof port-wine stains with the CO2 laser:Earlyresults in Arrdt KA,Noe JM Rosen S:Cutaneous Laser therapy:Principles and methods[J].New York,John wiley and Sons Inc.1983,129-136.
21.黄和平,胡琼华,易阳艳等.CO2激光治疗婴幼儿体表增殖性血管瘤[J].中国美容医学,2004,13(5):549-550。
22. 王淑香,于景芳.CO2激光治疗婴幼儿先天性血管瘤[J].激光杂志,2003, 24 (3) : 19,
23. Noe JM, Barsky SH, Geer DE, et al. Port wine stains and the response to argon laser therapy :successful treatment and the predictive role of color age, and biopsy [J].Plast Reconstr Surg ,1980,654:1306.
24. Finley JL, Healing of Port wine stains after argon laser therapy[J]. Arch Dermatol. 1981,117(8) :486 .
25.Achauer BM, Vander Kam VM.Vascular lesions[J].Clin Plast Surg, 1993,20:43.
26. Raulin C, Greve B. Retrospective clinical comparison of hemangioma treatment by flashlamp-pumped (585 nm) and frequency-doubled Nd: YAG(532 nm) lasers[J]. Lasers Surg Med, 2001, 28: 40-43.
27. Alster TS, Lupton JR. Lasers in dermatology. An overview of types and indications[J]. Am J Clin Dermatol. 2001,2: 291-303.
28. Holy A,Geronemus RG. Treatment of periorbital port-wine stains with the flashlamp-pumped pulsed dye laser[J]. Arch Ophthalmol, 1992, 110(6): 793.
29. Swinehart JM. Hypertrophic scarring resulting from flashlamp-pumped pulsed dye laser surgery[J].J Am Acad Dermatol, 1991,25:845.
30. Lou WW , Geronemus RG. Treatment of port-wine stains by variable pulse width pulsed dye laser with cryogen spray: a preliminary study[J]. Dermatol Surg, 2001. 27: 963—965.
31.Rothfleisch. JE, Kosann MK. Levine VJ , et al. laser treatment of congenital and acquired vascular lesions,A review[J].Dermatol Clin.2002,20:1-18.
32.蔡慧敏,张少渊,翁玲达等.595nm脉冲染料激光治疗皮肤血管性疾病临床分析[J].应用激光,2004,24[6]:418-419。
33.Reyes BA,Geronemus R.Treatment of port-wine stains during childhood with the falshlamp-pumped plused laser[J].Am Acad Dermatol,1990,23(6):1142-1148.
34.Dummer R.Graf P,Greif C,et al.Treatment of vascular lesions using the VemaPulse variable pulse width frequency doubled neodymium:YAG laser[J].Dermatology,1998,197:158-161.
35.赵恩兵,王黎,刘瑞红,等.Nd:YA G激光在小儿血管瘤治疗中的应用(附166例报告)[J].陕西医学杂志,2003,32(2):122-124.
36.Clark C,Cameron H,Moseley H,et al.Treatment of superficial cutaneous vascular lesions:experience with the KTP 532 nm laser[J].Lasers Med Sci,2004,19:1-5.
37.苑凯华,张超,廖元兴,等.不同波长激光治疗浅表性皮肤血管性疾病临床分析[J].中国激光医学杂志,2005,14(4):269.
38.陈小松.激光治疗鲜红斑痣351例临床疗效分析[J].福建医科大学学报.2005,39(1):89-90.
39.Finn MC,Glowacki J,Mulliken JB.Congenital vascular lesions:clinical application of a new classification[J].J Pedlar Surg,1983,18:894.
40.马丽,吴润达,金晓东,等.595 nm与585 nm激光治疗鲜红斑痣的疗效比较[J].临床皮肤科杂志,2003,32(3):168-169。
41.张劲松,李长根,方震.PhotoDerm VL/PL强脉冲激光治疗皮肤血管性疾病208例疗效分析[J].实用医学杂志,2004,20(6):661-662.
42.纪彦林,尹国胜,赵小忠等.脉冲激光治疗面部毛细血管扩张162例临床分析[J].临床皮肤科杂志,2001,30(4):243-244。
43.刘春利,高景恒.激光技术在整形美容外科的应用[J].实用美容整形外科杂志,2000,11(3):113。
44.Raulin C,Sehroeter CA,Weiss RA,et al.Treatment of port-wine stains with a noneoherent pulsed light source:a retrospective study[J].Arch Dermatol,1999,135(6):679-683.
45.陈天新,李芍华,王敏,等.595nm波长激光采用不同能量与脉宽对表浅血管的作用[J].中国临床康复,2004,32(8):7202-7203。
46.李志清 彭大文 赵蓉萍,等.三种波长激光联合治疗颌面部草莓状血管瘤[J].中国激光医学杂志,2006,15(3):170-172。
47.周国瑜,沈玲悦,田克斌,等.长脉冲可调脉宽Gentle YAG 1064nm激光治疗颌面部血管瘤113例效果评估[J].上海口腔医学,2006,15(3):150-153。
48.周展超,吴余乐.皮肤美容激光,第一版,南京;东南大学出版社,2000.9:50-51。
49.Muelller B U,Mull Iken JB.The infant with a vascular tumor[J].Semin Perinatol,1999,23(4):332-340.
50.Bartoshesky LE.Corticosteroid treatment of Cutaneous hemangiomas:how effective a report on 24 children[J].Clin Pediatr,1978,17:625.
51 苑凯华,刘春利,李勤等.VPW532nm波长激光与平阳霉素联合治疗小儿血管瘤[J].实用美容整形外科杂志,2000,11(6):306-308。
52.王肃生,梁 刚,张志华,等.平阳霉素及糖皮质激素与激光联合治疗儿童颌面部血管瘤[J].中国实用美容整形外科杂志,2006,17(2):95-97。
53.谭志建 刘凌 童晓荣,等.激素加脉冲染料激光治疗皮肤血管瘤疗效研 究[J].中华物理医学与康复杂志,2003,25(7):445-446。
54.李志清,尹明平,赵蓉萍,等.Nd:YAG激光联合平阳霉素治疗口腔血管瘤[J].中国激光医学杂志,2002,11(2):96-98。
55.邓波,谢红付,肖满兰.脉冲染料激光联合曲安奈德局部注射治疗小儿混合型皮肤血管瘤[J].临床皮肤科杂志.2003,32(7):418-419。
56.Seukeran DC,Collins P,Sheehan Dare RA.Adverse reactions of port wine stains in 701 patients[J].Br J Dermatol,1997,136:725-729.
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