平阳霉素治疗血管瘤与脉管畸形的不良反应分析  

Clinical analysis of the side effects of intralesional injection of Pingyangmycin in hemangiomas and vascular malformations

作　　者：寿柏泉[1] 寿卫东[2] 杨震[1] 张森林[1] 董震[1] 

机构地区：[1]南京军区南京总医院口腔科,江苏南京210002 [2]南京大学医学院附属南京市口腔医院口腔颌面外科,江苏南京210008

出　　处：《中国口腔颌面外科杂志》2008年第1期34-37,共4页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:总结平阳霉素(PYM)治疗血管瘤与脉管畸形的不良反应,为临床应用PYM治疗血管瘤和脉管畸形提供参考。方法:回顾1991年1月-2007年1月间采用PYM治疗血管瘤与脉管畸形的所有病例。其中190例发生不良反应,对不良反应的类型和原因进行分析。结果:采用PYM治疗血管瘤和脉管畸形1685例,发生不良反应190例,其中食欲缺乏68例,发热60例,皮疹23例,过敏性休克1例;血管瘤或脉管畸形局部坏死性溃疡38例,发生于口腔颌面部12例,躯干10例,四肢16例;36例经抗感染、换药痊愈,2例经皮瓣移植治愈。结论:注射PYM前先肌注地塞米松,可预防或减少发热和过敏反应。注射PYM后发生的局部坏死性溃疡,一般均可治愈,但上、下肢等血运较差的皮肤病变,PYM的剂量不宜超过3mg,浓度应在1∶2～1:3(1mg:2ml～1mg:3ml),作放射状注射,可避免因PYM一处聚积而致病变坏死。PURPOSE： To evaluate the side effects including necrotic ulceration of intralesional injection of Pingyangmycin （PYM） in treating hemangioma and vascular malformations. METHODS： The clinical data of 1685 hemangiomas and vascular malformations treated with intralesional injection of PYM were reviewed. Among them, 190 developed adverse effects. The types of the side effects and causes were analyzed. RESULTS： Of the 190 cases with side effects and necrotic ulcer, 68 had in appetence, 60 had fever, 23 had rash and 1 developed allergic shock. 38 patients had localized necrotic ulcer, 12 of which were in the oral and maxillofacial region, 10 in the trunk and 16 in the extremities. Thirty six were cured with anti-infection and dressing change. Two patients were successfully managed with flap transplantation. CONCLUSION： Injection of DAM prior to Pingyangmycin injection can prevent or reduce fever and allergy. Local necrosis after intralesional injection of Pingyangmycin can be cured with surgery and/or medication. In treating skin lesions with poor blood supply in the low extremities, the dosage of PYM should not be more than 3 mg with a concentration of between 1mg/2ml and 1mg/3ml, and the injection should be performed in several points, to avoid tissue necrosis due to PYM accumulation.

关 键 词：平阳霉素 血管瘤 脉管畸形 不良反应 休克 坏死性溃疡 

分 类 号：R732.2[医药卫生—肿瘤] R654[医药卫生—临床医学]