[yananshs]

Сообщение от korsak

Выглядит "наша" гемангиома вот так.
А насчет лазерного лечения мы у хирурга поинтересовались. Он сказал, что именно такая гемангиома лазером не лечится.

Попробуйте получить мнение другого, незаинтересованного реального врача. Мнение педиатричеcких ассоциаций Европы и Америки - выжидательная тактика. Российские хирурги, кто из финансовых соображений, кто по неведению, поскольку российская медицина была долго изолирована, часто настаивают на хирургическом лечении.

Nelson
497 Benign Vascular Tumors
Cynthia E. Herzog
HEMANGIOMAS
Hemangiomas are the most common benign tumors of infancy and occur in about 10% of term infants. The risk of hemangioma is 3 times higher in females than males. The risk is doubled in premature infants and 10 times higher in offspring of women who had chorionic villus sampling. Although hemangiomas can be present at birth, they usually arise shortly after birth and grow rapidly during the first year of life, with slowing of growth in the next 5 yr and involution by 10-15 yr of age.
Clinical Manifestations.
More than half of these tumors are located in the head and neck region. The majority are solitary lesions, but the presence of more than one cutaneous lesion increases the likelihood of visceral hemangiomas. The liver is the primary site of visceral involvement; other involved organs include the brain, intestines, and lung. Most hemangiomas require no therapy, but approximately 10% of hemangiomas cause significant impairment and 1% are life threatening because of their location. Hemangiomas around the airway can cause airway obstruction, and those around the eyes can result in loss of vision. Ulceration is a frequent complication and can lead to secondary infection. Large hepatic hemangiomas or hemangioendotheliomas may result in hepatomegaly, anemia, thrombocytopenia, and high-output heart failure.
Kasabach-Merritt syndrome is characterized by rapidly enlarging lesion, thrombocytopenia, microangiopathic hemolytic anemia, and coagulopathy as a result of platelet and red blood cell trapping and activation of the clotting system within the vasculature of the hemangioma. This syndrome has now been shown to be associated with kaposiform hemangioendotheliomas or tufted hemangiomas.
Cutaneous lesions can usually be diagnosed by typical appearance and rapid proliferation. Deep lesions may require imaging studies to help differentiate from a lymphangioma. The presence of a midline hemangioma in the lumbosacral area indicates the need for an MRI for underlying asymptomatic neurologic abnormalities. Location may also dictate the need for an ophthalmologic or surgical consultation. A scan of the liver should be performed if multiple cutaneous lesions are present.
Treatment.
Most require no specific therapy and only parental reassurance. For those hemangiomas that are life threatening or that threaten vital functions such as eyesight, treatment is warranted. Prednisone (1-3 mg/kg/24 hr PO) is typically the initial therapy. Occasionally, higher doses are used. Approximately 30% of hemangiomas respond dramatically to corticosteroids and begin to regress within 1 wk; 40% stabilize or show minimal response; and the remainder do not respond. Interferon-α (1-3 MU/m2/24 hr) has also been used as initial therapy and in those that do not respond to corticosteroid therapy. Although response rates of up to 70% have been reported, the risk of neurologic adverse effects in 10-20% indicates the need for caution in using interferon-α. Laser therapy has been used in some situations.
Treatment of patients with Kasabach-Merritt syndrome usually consists of supportive care while also beginning therapy with corticosteroids or interferon-α. Heparin therapy is contraindicated, and platelet transfusions should be avoided in the absence of life-threatening hemorrhage because they may exacerbate the bleeding. The use of aminocaproic acid or tranexamic acid may be beneficial. Failure to respond to therapy warrants the use of less conventional treatments, such as irradiation, embolization, or surgical resection.

Это цитата из современного классического учебника по педиатрии.