[Abstract] OBJECTIVE: To observe the clinical efficacy of different concentrations of Pingyangmycin in the treatment of various hemangiomas and different types of vascular malformations. Methods: A total of 162 cases of hemangioma and 153 cases of vascular malformation were admitted from 1998 to 2003. Different types and locations of hemangiomas or vascular malformations were treated with different concentrations of pinyamycin. The details were as follows: 8mg/8ml for cutaneous hemangioma, 8mg/5ml for subcutaneous and submucosal hemangioma, and 8mg/3ml for subcutaneous and submucosal vascular malformation. results: the efficiency of cutaneous hemangioma was 95%, that of oral mucosal hemangioma was 100%, that of subcutaneous vascular malformation was 92%, and that of mucosal vascular malformation was 97%. CONCLUSION: The effective therapeutic concentration of Pingyangmycin plays an important role in two different vascular lesions. The treatment with different concentrations of Pingyangmycin for different sites and types of vascular lesions can achieve better therapeutic effects and reduce unnecessary complications. Pingyangmycin has been widely used in the treatment of hemangiomas and vascular malformations in clinical practice, and has achieved good clinical results [1-3]. However, the pathological changes of hemangioma and vascular malformation are different, and the application of the same concentration to treat two different diseases is not likely to have the proper therapeutic effect, and whether the concentration causes prolonged treatment time, poor therapeutic effect, and undue complications is also an issue that needs to be discussed clinically. The author chose different concentrations of Pingyangmycin in clinical practice to treat hemangioma and vascular malformation respectively, and achieved obvious clinical effects, which are reported as follows. 1 .Data and methods 1.1 Classification of hemangioma and vascular malformation According to the hemangioma de? Panacea? A fear of throwing boing?] , clinical diagnosis was made according to the time of appearance of vascular lesions in clinical practice, the rate of tumor growth, the color of the tumor body surface, whether it was substantial, and whether it could be compressed. According to the above diagnostic methods, 162 cases of oral and maxillofacial hemangioma and 153 cases of vascular malformation admitted from 1998 to 2003 were analyzed, as shown in Table 1. Table 1 Analysis of 162 cases of hemangioma and 153 cases of vascular malformation (cases) 1.2 Treatment Routine examination of blood routine, liver function and chest X-ray before injection. 1.2.1 Preparation of injection solution for hemangioma (1) skin surface hemangioma: Pingyangmycin 8mg, 2% lidocaine 3.5ml, saline 3.5ml, dexamethasone 1ml (2mg); (2) mucosal and subcutaneous hemangioma: Pingyangmycin 8mg, 2% lidocaine 2ml, saline 2ml, dexamethasone 1ml (2mg). 1.2.2 Preparation of injection for vascular malformation Because Pingyangmycin only has effect on cavernous vascular malformation, but not on capillary malformation and arteriovenous vascular malformation, the prepared injection is limited to cavernous vascular malformation. Pingyangmycin 8mg, 2% lidocaine 1.5ml, saline 1.5ml, dissolved into 3ml of mixed injection solution. After strict disinfection, enter the needle from the normal tissue around the tumor, puncture with blood return, try to draw blood from the tumor, and then change the syringe to inject the drug. Solid tumor should be injected evenly into the tumor as much as possible, and the injection of body surface tumor should not be too shallow. According to the tumor site, tumor size, and patient’s age, 1~5ml should be injected. 15~30min should be compressed after injection, and postoperative anti-infection treatment should be given. Hemangioma is usually injected once in 10~14 days, and vascular malformation is injected once in 15~30 days. For severe hemangioma with faster tumor growth rate and larger tumor scope, the treatment method of oral prednisone, combined with local injection of Pingyangmycin, is also combined. The specific method is to take 3mg/(kg・d) orally once, and after the tumor shrinks, change to 1~2mg/(kg・d) orally once, and continue for another 2 weeks as a course of treatment. 1.3 Evaluation criteria of efficacy (1) Cure: the swelling disappeared completely and the color of skin and mucous membrane returned to normal for more than 1 year without recurrence; (2) Effective: most of the swelling subsided; (3) Ineffective: the swelling partially subsided or subsided insignificantly. 2 .Results The efficacy of local injection of Pingyangmycin in 315 patients is shown in Table 2. Table 2 Summary of efficacy of intratumoral injection of Pingyangmycin Cases (%) As seen from Table 2, the efficiency of cutaneous hemangioma reached 95%, oral mucosal hemangioma was 100%, the efficiency of subcutaneous vascular malformation was 92%, and mucosal vascular malformation was 97%. The mucosal vascular malformation and hemangioma with small scope can be cured by 1 injection, 10 cases of generalized fever and 3 cases of local ulceration. 3. Discussion In the early 1980s, Mulliken and Glowacki et al. proposed a biological classification method to divide vascular lesions into two categories: hemangiomas and vascular malformations, that is, according to the different histogenesis of vascular lesions: those with vascular endothelial cell proliferation are hemangiomas, while vascular lesions consisting of endothelium and lining of vessels without proliferative tendency become vascular malformations [1]. The new classification method further differentiates various vascular lesions in terms of the biological characteristics of their development, and provides more practical clinical guidance for the diagnosis, differential diagnosis, selection of treatment methods and judgment of prognosis of vascular lesions. The mechanism of action of Pingyangmycin in the treatment of hemangioma is mainly through the inhibition of vascular endothelial cells in the highly proliferating hemangioma by Pingyangmycin, in addition, Pingyangmycin also has a certain sclerosing effect, through the two effects to play the purpose of treatment of hemangioma. The treatment of vascular malformation with Pingyangmycin is mainly through the sclerosing effect of the drug. Therefore, if the same concentration is used to treat both diseases, it will not have the proper therapeutic effect. The author had taken the method of waiting for degeneration for hemangioma a few years ago, which seems a bit inappropriate now. According to the growth characteristics of hemangioma, the principle of early detection, early diagnosis and early intervention should be followed, instead of blindly waiting for degeneration so as not to miss the good opportunity of treatment. The author has also administered hormone therapy to hemangioma purely, which has certain clinical efficacy, but the efficacy of some hemangiomas is not certain, and there are certain signs of recurrence after stopping the medicine. Therefore, active treatment with Pingyangmycin is a more ideal treatment method, but of course, for some special cases, a combination of several methods should be used to achieve the best clinical results. There is an essential difference between hemangioma and vascular malformation in terms of pathological changes. Hemangioma is a true tumor with rapid growth and the main pathological change is the high proliferation of vascular endothelial cells. In contrast, vascular malformations are not true tumors and grow slowly, with the main pathological change being the expansion and increase in the number of blood vessels. For the classification of hemangioma and vascular malformation, it is not difficult to classify most clinical patients according to the characteristics of their biological behavior and pathological changes and clinical manifestations. Hemangiomas are usually found in the first few weeks of life and have a rapid growth rate. The clinical presentation is a body surface mass, bright red in color, substantial to palpation, generally incompressible, and postural test (-). In contrast, vascular malformations are usually present after birth and have a slower growth rate. The clinical presentation is a purplish-red swelling on the body surface, soft to touch, compressible, and postural test (+). The effective therapeutic concentration of Pingyangmycin will play a decisive role in the therapeutic effect of both. The author used different therapeutic concentrations for different vascular lesions, different sites and types, and achieved better therapeutic results and reduced unnecessary complications.