CAJ | 학술논문

目的：探讨不同介入方法治疗新生儿卡-梅综合征（K-MS）的疗效。方法回顾性分析2010年5月至2014年8月收治的12例新生儿K-MS患者的病例资料。根据患者血管瘤大小、部位以及血供特点分别选择局部硬化剂注射治疗、经导管血管内灌注栓塞治疗和联合治疗（局部硬化剂注射治疗+经导管血管内灌注栓塞治疗）。5例病灶最大径<5 cm的患儿采用局部治疗，4例病灶最大径5～10 cm的患儿采用血管内灌注栓塞治疗，3例病灶最大径>10 cm的患儿采用联合治疗，并对3种治疗方法的效果进行分析。疗效分为治愈、好转和无效。治愈：肿物完全或基本消退，血小板计数稳定在正常范围，半年以上无复发；好转：肿物明显缩小，血小板计数稳定在正常范围；无效：2个月后肿物无明显缩小，血小板计数无改善。结果12例新生儿K-MS患儿均成功治愈。5例局部硬化剂治疗患者首次治疗后当日，血管瘤局部张力减低，瘀斑变淡，经2~7个疗程治愈；4例血管内灌注栓塞治疗患者中3例1次治疗治愈，1例患者首次栓塞后1个月复发，行二期治疗后治愈；3例联合治疗患者经1次栓塞治疗后，血管瘤明显缩小，血小板计数上升，经2~3个疗程的局部硬化剂治疗后血管瘤基本消失，血小板稳定在正常范围。本组12例患者无并发症发生。结论介入方法治疗新生儿K-MS疗效肯定，依据血管瘤大小、部位及血供特点选择不同的治疗方法，可取得较好的效果。
목적：탐토불동개입방법치료신생인잡-매종합정（K-MS）적료효。방법회고성분석2010년5월지2014년8월수치적12례신생인K-MS환자적병례자료。근거환자혈관류대소、부위이급혈공특점분별선택국부경화제주사치료、경도관혈관내관주전새치료화연합치료（국부경화제주사치료+경도관혈관내관주전새치료）。5례병조최대경<5 cm적환인채용국부치료，4례병조최대경5～10 cm적환인채용혈관내관주전새치료，3례병조최대경>10 cm적환인채용연합치료，병대3충치료방법적효과진행분석。료효분위치유、호전화무효。치유：종물완전혹기본소퇴，혈소판계수은정재정상범위，반년이상무복발；호전：종물명현축소，혈소판계수은정재정상범위；무효：2개월후종물무명현축소，혈소판계수무개선。결과12례신생인K-MS환인균성공치유。5례국부경화제치료환자수차치료후당일，혈관류국부장력감저，어반변담，경2~7개료정치유；4례혈관내관주전새치료환자중3례1차치료치유，1례환자수차전새후1개월복발，행이기치료후치유；3례연합치료환자경1차전새치료후，혈관류명현축소，혈소판계수상승，경2~3개료정적국부경화제치료후혈관류기본소실，혈소판은정재정상범위。본조12례환자무병발증발생。결론개입방법치료신생인K-MS료효긍정，의거혈관류대소、부위급혈공특점선택불동적치료방법，가취득교호적효과。
Objective To explore therapeutic effects of different interventional approaches to neonatal Kasabach-Merritt syndrome (K-MS) Methods A retrospective analysis of therapeutic effects of different interventional approaches to K-MS in 12 neonates from May 2010 to August 2014. All the patients received local treatment (n=5), chemoembolization (n=4) and combined local treatment and endovascular chemoembolization (n=3), respectively, depending on size, location and blood supply of K-MS. The K-MS patients with angioma measuring< 5 cm, 5 to 10 cm and >5 cm received local treatment, endovascular chemoembolization and combined local treatment and endovascular chemoembolization, respectively. The patients were categorized as cured, improved and clinical inefficient, respectively, based on therapeutic effect. The criteria for cured patients were: (1) angioma faded completely or mostly; (2) the platelet count stabilized within the normal range; (3)no recurrence for more than six months. The criteria for improved patients were: (1) angioma shrinked significantly; (2) the platelet stabilized within the normal range. The criteria for clinical inefficient patients were: (1) agioma no obviously shrinked, the platelet count has no improvement over 2 months after interventional approaches. Results All the 12 patients with K-MS were cured and had no complication. Of the 12 patients, 5 patients received local treatment had decreased localized tension and ecchymosis of hemangioma at the first day of therapy, were cured after 2 to 7 courses of therapy. Of the 4 patients received endovascular chemoembolization, 3 were cured after one course of treatment, 1 had recurrent disease one month later after one course of therapy and were cured after the second course of treatment.One had recurrent disease a month later after one course of treatment and were cured after the second course of treatment. Three received combined local treatment and endovascular chemoembolization, angioma shrinked significantly and increased platelet count after the first course of treatment, and 2 to 3 courses local treatment were combined, hemangioma faded and platelet count stabilized within the normal range after 2 to 3 courses of local treatment. Conclusions Interventional therapy is the most effective treatment of neonatal K-MS.There are different interventional approaches to optimize treatment of neonatal K-MS depending on sizes, location and blood supply of K-MS.