What is the treatment of hemangioma and vascular malformation?

Currently, sclerotherapy is widely indicated for the treatment of hemangiomas and vascular malformations, and is often used in combination with other methods to improve the efficacy. It can be applied to almost all congenital vascular lesions such as hemangioma, venous malformation, arteriovenous malformation. The German sclerosing agent 1% ethoxylated sclerosing alcohol is the most widely used clinically in the past 30 years, the effect is positive and accepted worldwide sclerosing agent. German production of ethoxylated sclerosing alcohol injection is widely recognized internationally as the ideal sclerosing agent, but the reagent (drug) has not been approved by the State Drug Administration into the domestic market. In order to fill the gap in China, Shaanxi Tianyu Pharmaceutical Co., Ltd. set up a project in 1993 to research the domestic 1% ethoxylated sclerosing alcohol (subsequently named as polyglaucol by the state), which was officially launched in October 2008 as a national patent new drug after fifteen years of research and development. The molecular formula and molecular weight of polyglaucol injection are identical to those of German ethoxylated sclerosing alcohol injection, and they are the same compound with different names. As the preferred intravascular sclerosing agent, it is widely used in Europe and the United States for the sclerotherapy of various hemangiomas, venous malformations, varicose veins and cystic diseases, and its safety has been recognized by the international community. Its pharmacological effect is that after injection in the intravenous vessels, it can rapidly damage the endothelial cells of the blood vessels and cause the fibrin platelet and red blood cells at the site of action to gather and deposit to form thrombus and block the blood vessels immediately; after injection in the submucosal layer of the veins, it can compress the veins to reduce the rate and pressure of blood flow in the blood vessels and achieve the purpose of hemostasis. Due to the chemical effect, it causes sterile inflammation in the venous vessels and surrounding mucosal tissues, and after 1 week, tissue necrosis forms ulcers, and after 10 days, granulation tissue is formed, and after 3-4 weeks, dense fibrous tissue is formed and the venous lumen is occluded. Poly(cinnamyl alcohol) can be used as a foam sclerosing agent, i.e., the sclerosing agent and a certain proportion of gas (air or carbon dioxide) are prepared according to different preparation methods to form a foam agent with surface activity and applied to local sclerotherapy. In this way, the blood inside the tumor cavity can be drained away as much as possible after injection, increasing the contact area and time between the drug and the endothelium of the blood vessel, so that the drug can work better. According to the recommendation of the European Conference on Foam Sclerotherapy, there are three main methods of sclerosing foam production: the Monfreux method, the vortex (Tessari) method, and the vortex/suit method, of which the vortex method is the most widely used in clinical practice at present. At the same time, a study found that when the liquid to gas ratio is 1:4, the best liquid to gas stability and effect on blood replacement can be achieved, while maintaining the therapeutic effect, the dosage of sclerosing drugs can be significantly reduced, reducing the occurrence of adverse drug reactions. Since its launch in 2008, polyglaucine has been gradually applied in the treatment of hemangioma and vascular malformation-related diseases. With its lower complication rate and higher treatment efficiency, it has become the first-line treatment drug for related diseases and has been a hot spot reported in the exchange meetings of the national hemangioma professional group in the past. Our hospital carries out ultrasound-guided sclerotherapy injection technology, ultrasound can show the two-dimensional morphology of hemangioma, clearly display the infiltration range, and under the ultrasound guidance of polyglaucine injection, can choose the best injection site, the drug directly and uniformly injected into the lesion area, so that the disease area to maintain a long-lasting and high drug concentration, to achieve the purpose of treatment, while avoiding the previous “blind puncture At the same time, the disadvantages of “blind puncture” are avoided, and the chance of accidental injection into normal tissues is greatly reduced, which significantly reduces the occurrence of adverse reactions. The application of ultrasound in the treatment of hemangioma and vascular malformation has the following advantages: (1) sonography can identify hemangioma and vascular malformation, clarify the nature of the lesion, and provide a basis for drug allocation and injection method selection; (2) the dose of drug to be injected can be estimated according to the area and volume of the lesion, and the injection site can be precisely located according to the lesion site and characteristics; (3) multi-point injection under ultrasound guidance can enable the drug to be evenly distributed in the tumor, and the drug can be injected into the tumor. (3) Ultrasound-guided multi-point injection can evenly distribute drugs within the tumor, avoiding tissue necrosis caused by over-injection at one point and lesions remaining in other parts of the lesion due to insufficient drugs and poor efficacy; (4) For lesions with deeper locations or special sites, ultrasound-guided puncture injection can avoid important vessels, nerves, tendons and other important tissues, reducing the chance of tissue damage and the occurrence of serious complications; (5) Hemangiomas and vascular malformations If incompletely treated, they are highly prone to recurrence. Ultrasound exploration of residual lesions and targeted precise treatment will greatly reduce the recurrence rate of lesions.