传统的"血管瘤"(Vascular Anomalies)包含了各种血管性肿瘤和血管/淋巴管畸形,在中国有逾2千万病例.疾病谱中既涵盖常见病,如婴幼儿血管瘤,在新生儿中发病率高达1％～ 10％;也涵盖罕见疑难病,如颅外动静脉畸形,发病率约为1/20万,却是国际公认的疑难疾病.这些疾病可发生于全身各部位,累及多器官,造成多种多样的临床表现,治疗所涉跨越各学科解剖界限、知识和技术,远非传统单一学科所能胜任.

目的 评估病灶内注射博来霉素治疗疣状静脉畸形的安全性和有效性.方法 本前瞻性研究纳入2016年至2022年在上海交通大学医学院附属第九人民医院接受病灶内注射博来霉素治疗的18例疣状静脉畸形患者(16例局限型病灶和2例弥漫型病灶).由3名和本研究无关的医生根据治疗前后的照片(主要评价指标)和MRI或多普勒超声检查结果(次要评价指标)来评估治疗效果,并记录期间不良事件和副作用的发生情况.结果 77.8％(14/18)的患者得到了良好效果的评价,22.2％(4/18)的患者被评价为无效,其中包含2例弥漫型病变.局限型疣状静脉畸形治疗的良好效果为87.5％(14/16),且未导致严重并发症.结论 病灶内注射博莱霉素可减少局限型疣状静脉畸形的表面积和体积,是局限型疣状静脉畸形病变的有效治疗方法.

过去的一年余,手术和非手术面部年轻化领域,无论除皱手术、解剖学、埋线悬吊提升、注射,还是激光光电领域,都取得了不少令人侧目的进展,以下更值得关注,比如:"斜拉桥"除皱术式;氨甲环酸的局部浸润注射和静脉用药可减少出血;利用AI技术评估除皱术后的外貌年龄;除皱术后暂时性的面神经损伤的健侧A型肉毒毒素注射临时调整;透明质酸加速其中PDO缝线的降解;注射透明质酸可诱导下颏骨吸收;钝针注射后血管意外栓塞的发生率比锐针低得多;SVF辅助的脂肪注射的脂肪更为优化;Er:YAG激光全面部剥脱性治疗需要关注的安全参数等,当然,这些新的结论是否正确,还需要在后续的临床前瞻性研究中继续跟进.

面部手术导致的瘢痕,会给患者的生活、社交带来严重的心理问题,严重影响了患者对手术的满意度.相关研究显示,针对面部手术切口进行早期干预,可有效改善术后的切口瘢痕.本文就面部手术切口瘢痕的早期干预的研究进展进行综述.

婴幼儿血管瘤(IH)是于婴儿出生不久后产生的良性肿瘤，发生在颜面部的血管瘤若未在早期接受妥善治疗，可影响患者的社交、就业及心理健康，给家庭带来负担，因此，IH的早期诊治和预防很重要。该综述主要归纳近十几年来临床研究中与IH相关的产前风险因素，其中较显著因素为流产史、人工受孕、绒毛膜取样、孕早期阴道流血、胎盘异常、孕期服用黄体酮、妊娠期高血压、妊娠期糖尿病、妊娠期吸烟、饮酒，为今后的临床研究及基础研究提供帮助。

疣状静脉畸形,又称疣状血管瘤,是一种少见的先天性血管病变,通常在出生时或儿童早期被发现,随生长发育病症逐渐加重,不会自发消退.初期表现为边界较为清楚的红斑,随生长发育逐渐增厚?角化和出现疣状增生.目前普遍认为手术切除是治疗的首选方法,切除不彻底将导致病变复发.冷冻?电灼?激光?硬化疗法等可作为手术治疗的辅助方法,以防止复发或延缓病情发展.本文对疣状静脉畸形诊断与治疗的相关文献进行回顾综述,以期为临床疣状静脉畸形的诊断及治疗提供帮助.

COVID-19疫情在全球肆虐之际,由加拿大温哥华举办的血管瘤领域最权威的国际血管瘤和脉管畸形研究学会( ISSVA)研讨会,于2020年5月14～15日以网络形式召开.ISSVA是国际公认的本领域创造性基础研究和新治疗探索的发动平台.每两年一次的 ISSVA 大会吸引着全球 40～70个国家参会,各发达国家更是少有缺席.ISSVA所有大会发言和壁报均由科学委员会通过盲评产生,均是未发表的原创发现.本届研讨会共有52个国家的学者参会,入选大会发言84篇,其中亚洲仅入选7篇,均来自上海交通大学医学院附属第九人民医院整复外科林晓曦教授团队,林晓曦教授是会场主席中唯一的亚洲学者.会议入选的壁报发言共146篇,亚洲入选25篇(其中的22篇同样来自林晓曦教授团队).

目的 评价长脉宽Nd:YAG激光治疗浅表静脉畸形的疗效和安全性.方法 前瞻性纳入18例浅表静脉畸形患者,采用长脉宽Nd:YAG激光进行治疗,治疗间隔2个月,治疗终点为病灶清除率大于90％,采用治疗前后照片对比进行疗效评价.记录水泡、色沉、毛细血管扩张和瘢痕等不良反应.治疗结束后随访12个月,评价复发率,复发判定标准为治疗后的区域复现10％以上的蓝色血窦.结果 经过1～4次(平均2.4次)的治疗,全部患者均可达到90％以上的病灶清除率.不良反应:水泡3人4例次,色素沉着5人9例次,毛细血管扩张3例;无瘢痕增生病例,无复发病例.结论 长脉宽Nd:YAG激光可有效治疗浅表静脉畸形,是一种安全有效的方法.

The incidence of infantile hemangioma (IH) is relatively high,resulting in the necessity of early treatment.Topical medicine is safer than oral administration.This paper reviews the main topical drugs for IH and related mechanism,current situation and the prospect of topical beta blockers for IH.

目的 研究婴幼儿血管瘤消退后远期皮肤改变的情况,探讨不同皮肤后遗症的治疗方案.方法 对2008年1月至2011年12月来我科就诊的671例深部型及混合型婴幼儿血管瘤患儿进行随访,统计总结血管瘤消退后的皮肤情况.结果 最终收取280例有随访照片的患儿,消退后的正常皮肤率为39.6％.在瘤体消退后皮肤残留外观改变的事件中,毛细血管扩张的发生率最高(34.3％),纤维脂肪残余次之(23.6％),皮肤皱褶及疤痕发生率较低(8.6％及10％).卡方检验证实,混合型瘤体消退后正常皮肤率(30.7％)显著低于深部型(61.7％).结论 局部隆起的婴幼儿血管瘤,消退后完全恢复为正常皮肤的概率较低,可对患儿造成永久性的外观改变.瘤体的类型可能影响最终消退后的皮肤外观,但相关因素的分析需要进一步的数据证实.

目的 探讨采用点阵射频微针改善下面部与颈部松弛的临床疗效与安全性.方法 自2017年8～12月,对9例具有轻中度下面部与颈部松弛、脂肪堆积、轮廓不满意的患者,采用点阵微针射频治疗,1次/月,共计3次;随访3个月,由未参与本研究的临床医师根据术前与术后随访照片,采用盲法评估疗效,并由患者进行满意度自我评价.结果 9例接受治疗的患者中,1例因治疗时疼痛,在接受1次治疗后退出本研究;余8例完成3次治疗并接受随访.6例术后面部轮廓明显改善,患者满意度为87.5％.结论 点阵射频微针可有效改善轻中度下面部与颈部的松弛,是一种简便、安全、有效的治疗技术.

Objective To investigate an operative method of autologous fat transfer to retro-orbicularis oculi fat (ROOF) through upper blepharoplasty incision for correction of superior sulcus deformity and dermatochalasis,and to evaluate the efficacy and safety of the method.Methods ROOF lies in the lateral supraorbital area.Autologous fat transfer to ROOF through upper blepharoplasty incision was performed in patients selected by examination.The efficacy and safety were evaluated by follow-up study.Results From March 2013 to June 2017,23 selected patients received the treatment with 3 months to 50 months (mean,20.4 months) follow-up.The amount of fat graft for each palpebra was 0.6 to 2.0 ml,and the mean graft amount was 1.4 ml.The superior sulcus deformity improved significantly in 22 (95.7％) cases.All 23 cases achieved significant improvement of dermatochalasis.22 (95.7％) cases were satisfied with the result.No major complications occurred.Conclusions Autologous fat transfer to ROOF through upper blepharoplasty incision is effective and safe in correction of superior sulcus deformity and dermatochalasis,The operative method should be a good choice for selected patients.

皮肤老化是渐进性的发展过程,与内因性衰老和外源性老化有关.皮肤松弛是皮肤老化的重要表现,除了传统的外科手术治疗外,还有多种非手术治疗方式,包括激光、射频、聚焦超声、光电协同以及其它联合治疗.本文总结了近一年来面颈部皮肤松弛光电治疗领域的相关研究,对改善皮肤松弛的仪器、种类、参数、疗效和安全性进行整理,期望对临床治疗有所帮助.

Objective To explore a more accurate method in the area measurement of curved surface such as orbital rim.Methods Twenty-six NF1 patients were acquired.CT scan on both sides of the orbit and 3D reconstruction were completed.The orbital rim area was measured in approximate coronal plane and 3D curved plane respectively.The data were statistically analyzed.Results On average,the data of the plane method were underestimated,compared with the 3D method.There was statistical difference between the two groups.Conclusion The measurement in 3D curved plane is accurate,stable and easy to operate,which can replace the measurement in approximate coronal plane.

Objective To explore the clinical efficacy of modified nasolabial rotation flap in the reconstruction of upper lateral lip subunit. Methods Ten patients suffering from large treatment-resistent port wine stains or hemangiomas of upper lips were recruited, whose defect/upper lateral lip ration were more than 50 percent. Modified nasolabial rotation flaps were used to reconstruct the upper lateral lip subunit. Results All flaps were survived. No flap loss was noted. All scars were hidden into the borders of the upper lateral lip subunit and were outlined by the philtrum column, nostril sill, alar base and nasolabial fold. The results were satisfactory. Conclusion Modified nasolabial rotation flaps based on upper lateral lip subunits are reliable for reconstructing large, superficial defects of the upper lateral lip aesthetically and functionally.

Objective To compare the efficacy and safety of simply topical timolol 0.5% cream and timolol combined with intralesional Diprospan in the treatment of thick superficial infantile hemangiomas(IH). Methods From January to November 2015, 43 patients with thick superficial IH(2 ~6 mm) were recruited for a self-control study. Half lesion was treated with topical timolol 0.5% cream simply, while the other was treated with topical timolol 0.5% cream combined with Diprospan injection. Cream was applied four times daily for five months, and the injection of Diprospan was given every 4weeks. The injection time depended on tumor thickness and the effect, when the depth of lesion was less than 2 mm or no further improvement was observed after three treatment procedures, injection treatment should be stopped. Finally, according to the thickness, the color and area score, the effective rate and the incidence rate of adverse reaction were compared between the two groups. Results Thirty-eight patients with thirty-night lesions finished the research. The efficacy rates of topical timolol group and combined treatment group were 92.3% and 97.4%, no significant difference was observed. The combined treatment group exhibited better effect than timolol cream group, especially in the involution of thickness, color and onset time, while not in the involution of area. The side effects included ulceration(5.13%) and soft tissue atrophy(5.13%)were observed in combined treatment group and peeling(2.56%) in both group. Conclusion Compared with simply topical cream, intralesional Diprospan combined with topical timolol 0.5% cream has a better effect for treating superficial IH with a certain protruding degree in the aspects of thickness, color and onset time.

Objective To explore the differential diagnosis of NF1 and vascular malformation using genetic testing.Methods A 10-year old boy’s right calf, with scattered erythema, has enlarged without definite boundaries for one year.More than 6 Café au lait, with diameter larger than 1.5 cm, scattered all over the trunk and limbs. CT: capillaries and superficial vein of right calf increased and enlarged, with an impression of tendency to venous malformations. In accordance with NF1 diagnosis criterion, it could not be diagnosed as NF1 without other typical symptom except caf é au lait. Then NF1 gene detection was performed. Results NF1 nonsense mutations was detected after DNA sequencing, c.C. 4006 C>T, p.Gln 1336 *(hybrid), supporting for NF1 diagnosis. Conclusion Genetic testing can be performed to help the diagnosis for the patients with atypical clinical manifestations.

Objective To explore the etiology, clinical features and treatment strategies of secondary cleft lip resulting from ulcerated hemangiomas. Methods A retrospective analysis of IH from Dec 2012 to Jan 2014 was performed. The etiology, clinical features and treatment strategies of secondary cleft lip resulting from ulcerated hemangiomas were analyzed.Results The medical records of 528 IH were examined. 33 IH(20 girls and 13 boys) located in lip area. Only 3 developed ulceration, and 2 of 3 resulted in secondary complete cleft lip, both girls. Propranolol was used at 2 mg/kg/d to treat the IH just one week after ulceration, the cleft lip inevitably happened after medicine therapy. Both patients received surgical repair of cleft lip and obtained good results. Conclusion Cleft lip is a rare complication of ulcerated hemangioma. Propranolol can not prevent cleft lip after the ulceration of IH absolutely. An early stage repair surgery at the beginning of involuting phase is more helpful in reducing pain and uncomfortable of both physical and psychological than the repair after an absolute involution.

Objective To explore the clinical outcomes of periorbital elevation and positioning with secret incisions for the repair of periorbital cutaneous defects. Methods From 2014, 11 palpebral defects were repaired with this technique.The width of defects ranged from 0.8-2.9 cm. With incisions along the palpebral margins and unilateral vertical edge of the lesions, the defects were repaired by periorbital elevation and positioning. Results All patients received significant improvements except 1 case with small necrosis and 1 case with an asymmetric palpebral fissure with a mean follow-up of 8months. Conclusion Application of periorbital elevation and positioning with secret incisions could get satisfactory outcome and one-stage repair for periorbital cutaneous defects. And it’s an ideal technique in periorbital region.