Local Cryoablation Hemangiomas in Children

Abstract


Relevance Hemangiomas - the most common in early childhood benign vascular tumors. Treatment of vascular tumors and challenge still remains the subject of discussion of many experts, as evidenced, as a waiver of any medical or surgical intervention on the involution c hope, and offers a large number of different treatments. The purpose of the study Improvement of treatment of hemangiomas in children by local cryoablation according to the ultrasound picture of education. Materials and methods Experimental. For the identification of a mechanism for cryotherapy hemangioma, we conducted an experiment on the model of vascular tumor crest of live chickens. For the experiment using ridges 20 live chickens at the age of 150-200 days. The experimental scheme was as follows. Scallops on the first group of chickens was performed cryotherapy (liquid nitrogen) on an area of 1.5 cm 2 exposure of 30 seconds. As a control group of birds, the scallops are not affected. After the experimental exposure was carried out daily visual monitoring of birds and morphological changes scallop chickens. Crest biopsy was performed at 1, 4, 8 and 14 of the study. Clinical section. For 2008-2009. hospitalization GOOSE "DRKB number 1" asked 487 children, who revealed 540 hemangiomas. After clinical evaluation in 214 children (43.94%) performed ultrasound of hemangiomas, conducted 232 surveys. In 435 patients treated with cryotherapy hemangiomas started due to the fact that the patient was exposed to a preliminary diagnosis of capillary hemangioma. Results and their discussion In the experiment, after cryoablation on the first day of the integrity of the scallop is not broken, the cells clear. By 4 days is a violation of the integrity and structure of the surface layer of the vascular and the surrounding connective tissue layer, the structure of which is bubbly. Marked migration of fibroblasts and macrophages, the formation of fibrous tissue. To a lesser extent affected fibro-fatty layer and place in a large caliber vessels there. On the 8th day of the ongoing destruction of frostbite tissue rejection of the surface layer. Observed a tenfold increase in the number of fibroblasts, the large size of the cytoplasm with clear boundaries. Appear around the cells of connective tissue fibers yellow. By 14 days of elastic fibers are replaced by collagen. Collagen fibers to orient the intercellular substance. There is a destruction of fibroblasts to form in their place of continuous acellular collagen strands, followed by the formation of thin fibrous strands of vascular and connective tissue layers and their subsequent epithelization. Found that the method of cryoablation not guarantee 100% recovery in the treatment of hemangiomas. Recovery occurred in only 66.21% of patients who underwent cryoablation. Results kriolecheniya hemangiomas depends on the severity of the subcutaneous component of the presence or absence of feeding vessels. In 33.79% cryotherapy was ineffective in some cases been successful only in the skin, subcutaneous component continued to grow. When the skin with subcutaneous hemangiomas feeding vessels after krioaplikatsii recovery does not occur, after 2-3 weeks there is a renewed exophytic growth. When the skin with subcutaneous hemangiomas component and subcutaneous feeding vessels after cryoablation observed the opposite effect - the rapid growth of hemangiomas, recovery occurred after surgical or combined treatment. Conclusion Lack of subcutaneous vascular pattern accented or branched component in patients with a preliminary diagnosis of capillary hemangioma on ultrasound mode DRC found only in 44% of cases. When cavernous hemangioma and mixed by ultrasound mode DRC branched components in a mixture of 56% is observed, branching venous component of character - in 36% of the components of blood and branching character - 8%. The results of cryosurgical treatment of hemangiomas depends on the severity of the subcutaneous component of the presence or absence of feeding vessels: with capillary hemangiomas of the skin without subcutaneous component and lack of vascular pattern accented with DRC recovery occurs after one session cryoablation in 79% of cases and after 2 sessions - in 21% of cases. When the skin with subcutaneous hemangiomas component, capillary or cavernous vascular pattern accent and no feeding vessels, as detected by the DRC after cryoablation was successful on the skin, subcutaneous component continued to grow, although not extensively, recovery occurred after surgery, or combined treatment. When the skin with subcutaneous hemangiomas feeding vessels revealed by the DRC, even in the absence of other changes in the subcutaneous tissue after cryosurgical treatment recovery does not occur, after 2-3 weeks there is a renewed exophytic growth and recovery - after surgery or combined treatment. When the skin with subcutaneous hemangiomas and subcutaneous component supply vessel revealed by the DRC after cryoablation opposite effect was observed, the rapid growth of hemangiomas, the recovery - after surgery or combined treatment.

Mordovian State University N. P. Ogareva, Saransk, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
MD, Professor of the Pediatric Surgery Course of the Department of Faculty Surgery of the Medical Institute of Mordovia State University named after N.P. Ogarev, Saransk

Children's Republican Clinical Hospital, Saransk, Russian Federation

Email: author@vestnik-surgery.com
Surgeon of the Children's Republican Clinical Hospital of Saransk

Mordovian State University N. P. Ogareva, Saransk, Russian Federation

Email: author@vestnik-surgery.com
MD, Professor, Head of the Department of Faculty Surgery of the Medical Institute of Mordovia State University named after N.P. Ogarev, Saransk

Republican perinatal centr, Saransk, Russian Federation

Email: author@vestnik-surgery.com
MD, Director of the Republican Perinatal Center of Saransk

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