• Treatment of cavernous genmangiomas in children using two-phase thermal destruction
en To content Full text of article

Treatment of cavernous genmangiomas in children using two-phase thermal destruction

PAEDIATRIC SURGERY.UKRAINE.2019.1(62):6-10; DOI 10.15574/PS.2019.62.6

Bodnar B. M., Bodnar O. B., Rybalchenko S. V., Bodnar G. B., Roshka A. I.
HSEE of Ukraine «Bukovinian State Medical University», Chernivtsi

Objective. Analyze and compare the results of treatment of cavernous genmangiomas in children through the use of cryotherapy and new two-phase thermal destruction.

Material and methods. The study included 138 patients aged from 1 month to 3 years, for 6 years (2011 – 2018 years). Male patients were 53 (38.4%), female 85 (61.6%). The following localization of hemangiomas is established. Head and neck hemangiomas were in 45 (32.6%) children, on the back – in 18 (13.0%), on the front surface of the chest and abdomen – in 28 (20.3%), buttocks and perineum – in 14 (10.1%), upper and lower extremities – in 33 (24.0%). Further studies established the size of hemangiomas: up to 3 cm – in 27 (19.6%), from 3 to 5 cm – in 62 (44.9%), from 5 to 10 cm – in 31 (22.5%), from 10 to 15 cm – in 18 (13.0%) children. According to the survey, depending on the number of hemangiomas, patients had one hemangioma in – 52 (37.7%), two – 35 (25.4%), three in – 28 (20.3%), four or more in – 23 (16.6%).

Results. A complete examination was performed for all patients, including: complete blood count, urine analysis, electrocardiography (EKG), consultation with a pediatrician, cardiologist, neurologist and orthopedist. According to research, an additional chord in the left ventricular cavity was found in 27 (19.6%), hip joint dysplasia in 18 (13.0%), hernia of the anterior abdominal wall in 22 (15.9%). In all 100% of patients, ultrasound (US) of hemangiomas was performed in the gray scale mode, as well as in the duplex mapping mode (DC). According to the ultrasound study, as well as the DC, it was established that all hemangiomas had more than 5 feeding vessels, which were connected to each other by the anastomosis. Patients are divided into two groups in order to determine the actually developed new method. The first group included 87 (63.1%) patients for whom cryotherapy was the main treatment method (t=-196°C). The second group included 51 (36.9%) patients, and the treatment method was two-phase thermal destruction (t =-196°C for 60 seconds, and then t=+ 45°C for 2-3 minutes). Meanwhile, their own long-term results and electron microscopic examination and histoimmunological data in 14 (16.0%) out of 87 (100%) patients indicate that hemangioma tissue did not occur and as a result, a relapse of the disease occurred, which required repeated cryodestruction. Comparing the duration of treatment, we found that when using monophasic thermal decomposition with cold (t=-196°С), the duration of treatment was up to 14±0.9 days, with an established relapse in 14 (16.0%) patients. When using two-phase continuous thermal decomposition (first with cold t=-196°C, and then with heat t=+ 45°C), the duration of treatment was up to 11±0.25 days with no disease recurrence.

Conclusions. The method of two-phase continuous thermal destruction is safe in the treatment of cavernous hemangiomas and can be used on an outpatient basis. The method is economically justified and has the best results of treatment, namely: the absence of cosmetic defects, keloid scars due to the complete degradation of the hemangioma tissues and the replacement of elastic connective tissue. Meanwhile, the choice of the method of treatment of cavernous hemangiomas should be based on a comprehensive survey, an explanation to parents, and also pursue a goal on the quality of life of patients in the longterm period after treatment.

Key words: children, hemangioma, treatment, cryodestruction, two-phase thermal destruction.

REFERENCES

1. Benzar IM, Levytskyi AF, Blikhar VIe. (2017). Sudynni anomalii u ditei. Ternopil: TDMU: 360.

2. Bodnar BM, Unhurian AM, Denysenko OI, Bodnar HB. (2016). Sposib likuvannia khvorykh na kontahioznyi moliusk iz zastosuvanniam aparatnoi krioterapii. Deklaratsiinyi patent Ukrainy na korysnu model. No. 83421 MPK 201.01 A61M 18/02, A61 F7/00, A61P31/00. A61 P 29/00. Zaiavleno 26.04.2016r. Opublikovano 10.11.2016r., Biul. No.21.

3. Kuzyk А, Mohylyak O, Romanyshyn B, Lukavetskyy I, Nakonechnyy A, Synyuta A, Zakharus M, Avramenko I, Stegnitska M. (2017). Using of propranolol in conservative treatment of haemangiomas in infants. Paediatric Surgery. Ukraine. 4(57): 35–40. https://doi.org/10.15574/PS.2017.57.35

4. Rybalchenko VF, Rybalchenko IH, Demydenko YuH. (2017). Evoliutsiia khirurhichnoi ta likuvalnoi taktyky pry velykykh hemanhiomakh u ditei. Ukraynskyi zhurnal khyrurhyy. 4 (35): 96–99. http://dx.doi.org/10.22141/1997-2938.4.35.2017.118896

5. Rybalchenko VF, Rybalchenko IG, Demidenko YuG. (2017). Treatment of intradermal and superficial hemangiomas in children. Childs health. 12;8: 52–56. https://doi.org/10.22141/2224-0551.12.8.2017.119252

6. Spakhi OV, Pakholchuk OP, Kokorkin OD, Mariev GS. (2017). Treatment peculiarities of complicated due to its localization infantile hemangiomas. Paediatric Surgery. Ukraine. 1(54): 49–51. https://doi.org/10.15574/PS.2017.54.49

7. Tolstanov OK, Rusak PS, Danilov OA, Lankin YuM, Zaremba VR, Rybalchenko VF, Mariinsky GS, Vishpinsky IM, Shevchuk DV. (2018). Electric welding of living soft tissues in paediatric surgery: experience and development prospects. Paediatric Surgery. Ukraine. 1(58):28–36. https://doi.org/10.15574/PS.2018.58.28

8. Fomin AA, Konoplitsky DV, Kalinchyk ОО. (2017). Justifiability of expectation of involution in hemangioma program treatment in children. Paediatric Surgery. Ukraine. 3(56): 114–119. https://doi.org/10.15574/PS.2017.56.114

9. Benzar I, Fidelskyy V, Blikhar V. (2014). Treatment option of lymphatic malformations in young children. 15th Congress of the European Pediatric Surgeons’ Association, Dublin, Ireland, 18-21st June. Abstract Book: 281–282.

10. Benzar IM, Blikhar VY. Treatment of lymphatic malformations with OK-432. Thesis of 4th World congress of Pediatric Surgery, Berlin, October, 13th – 16th. P. e21/24.

11. Liu Q, Jiang L, Wu D, Kan Y, Fu F, Zhang D, Gong Y, Wang Y, Dong C, Kong L. (2015). Clinicopathological features of Kaposiform hemangioendothe-lioma. Int J Clin Exp Pathol. 8(10):13711–13718.

12. Yuan SM, Shen WM, Chen HN, Hong ZJ, Jiang HQ. (2015). Kasabach-Merritt phenomenon in Chinese children: Report of 19 cases and brief review of literature. Int J Clin Exp Med. 8(6):10006–10010.

Article received: Nov 04, 2018. Accepted for publication: Mar 07, 2019.