Yintoni iHemangioma Yentsana?
Ihemangioma yentsana (IH) yintshukumo yomzimba engalunganga eyakhiwe ngama-endothelial cells akhula ngokukhawuleza — iicell ezijolise kwiindawo zegazi. Yintshukumo evamile kwiintsana, ithinta malunga neepesenti eziyi-4 ukuya kweziyi-10 zeentsana zeCaucasian, kunye nokuphakama okuphantsi kwiindawo zeAsia kunye neAfrika. Ihemangiomas zenzeka ngama-2 ukuya kuma-3 ngaphezulu kwiintombi kunamadoda, kwaye iintsana eziphuthumayo kunye nezo zine-weight ephantsi zikhona kumngcipheko ophakamileyo.
Le miphunga ivame ukuvela phakathi kweveki zokuqala zokuphila, ikhokelwa ngophawu oluncinci okanye oluncinci oluphuma ngexesha lokuzalwa. Ihemangiomas zentsana zingavela naphi na emzimbeni kodwa zenzeka kakhulu entloko nasezithweni, zenza malunga neepesenti eziyi-60 zeemeko. Zihlukaniswa ngokujolise: ihemangiomas eziphezulu ziquka kuphela i-dermis ephezulu kwaye zivele njengezinto ezibomvu, eziphakamileyo, ezineelobhu (ihemangioma ye-strawberry); ihemangiomas ezijulile zihlala kwi-dermis ephantsi kunye nezicubu eziphantsi, ziveza njengezinto ezimblue, ezixhathisayo ngaphantsi kwesikhumba esigciniweyo; kwaye ihemangiomas ezixubeneyo zinezingxenye eziphezulu nezijulile.
Ubungakanani buphakathi kwemilimitha embalwa ukuya kumacentimeter ambalwa, kwaye nangona uninzi lwayo luyodwa, malunga neepesenti eziyi-15 ukuya kweziyi-20 zeentsana ezithintekayo zinehemangiomas ezininzi. Ngaphandle kokuba zivele zibonakale kakhulu kwaye zikhule ngokukhawuleza ekuqaleni, inani elikhulu lehemangiomas zentsana alinakubangela ingxaki kwaye landela umjelo ophawulekayo wokukhula, ukugcinwa, kunye nokuphuma ngokwempontshisi.
Izigaba Ezintathu: Ukukhula, I-Plateau, kunye ne-Involution
Ukuqonda imbali yemvelo yehemangiomas yeentsana kubalulekile ukuze kulawulwe ngokufanelekileyo, njengoko le mikhono ilandela umjikelo ophawulekayo onemijikelo emithathu eyahlukeneyo. Umjikelo wokukhula uqala kwiiveki zokuqala zokuphila kwaye ubonakaliswa kukukhula ngokukhawuleza kwehemangioma. Uninzi lokukhula luqhutywa kwiinyanga ezintathu ukuya kwezinye, kunye neepesenti ezingama-80 zendawo enkulu efumaneka ngokubanzi kwiinyanga ezintathu zokuphila.
Ngexesha le mjikelo, ihemangiomas eziphezulu ziba mnyama, ziphakamile, kwaye zineempawu ezahlukeneyo, ngelixa ihemangiomas ezinzulu zikhula njengeemass ezimnyama, eziphathekayo. Ukukhula kungaba yingozi kubazali — iphuzu elincinci elibomvu lingakhula libe ngaphezulu kwemizuzu emininzi — kodwa lo mjikelo wokukhula uyazikhusela. Umjikelo weplato ulandela, ngokubanzi uqala malunga neenyanga eziyi-6 ukuya kweziyi-9 zokuphila, ngexesha apho ihemangioma iyeka ukukhula kwaye ihlala ifanelekileyo.
Umbala unokuthi uqale ukuncipha ukusuka kumnyama obomvu ukuya kumnyama opholileyo. Lo mjikelo unokuhlala kwiinyanga. Umjikelo wokuhla (ukuhla) yinto ebalulekileyo ehlukanisa ihemangiomas yeentsana kwezinye iimeko ze-vaskhuli.
Ukuhamba ngokwakho kuqala njengoko iicell ze-endothelial zisebenza kwi-apoptosis kwaye zikhutshelwa kancinci kwi-tissue ye-fibrofatty. Umbala uncipha ukusuka kumnyama ukuya kumthubi okanye opholileyo, kwaye imass iyancipha kancinci. Ukuhamba kwenzeka ngexabiso elilinganiselweyo leepesenti eziyi-10 ngonyaka — ngonyaka wesihlanu, iipesenti ezingama-50 zokuhla ziqhutywa; ngonyaka wesixhenxe, iipesenti ezingama-70; kwaye ngonyaka wesixhenxe ukuya kweshumi, uninzi lwehemangiomas luye lwahamba ngokupheleleyo. Nangona kunjalo, ukuhamba ngokupheleleyo akubangela ukuba kubuyiswe ngokupheleleyo: utshintsho olusasele, kubandakanywa i-telangiectasias, i-masses ye-fibrofatty, isikhumba esiphindaphindiweyo, okanye i-scarring (ikakhulu ukuba ihemangioma ibonakaliswe) ingahlala kwaye ifuna ukulungiswa kamva.
Xa iHemangiomas ifuna ukunyango okungxamisekileyo
Nangona uninzi lwehemangiomas yeentsana lungabangelwa kwaye luyazixazulula, malunga neepesenti eziyi-10 ukuya kweziyi-15 zifuna ukunyango olusebenzayo ngenxa yeendawo zazo, ubungakanani, okanye iingxaki. Ihemangiomas ezisongela umgca wombono — ihemangiomas ze-periorbital ezivimba umbono okanye zibangele i-asthenopia ngokucinezela kwi-ophthalmology ephuhlayo — zifuna ukungenelela okungxamisekileyo kuba ukungabikho kombono ngexesha elibalulekileyo lokuphuhliswa kombono kungabangele i-amblyopia engapheliyo (i-lazy eye).!! Ihemangiomas ze-airway, ngakumbi ihemangiomas ze-subglottic kwi-trachea, zingabangela i-stridor eqhubekayo, ukungaphumi komoya, kunye nokuvinjelwa komoya okungabangele ubungozi bokuphila.
Ezi zihlala zixhaphakile kwihemangiomas ze-segmental cutaneous kwiindawo zokukhula kwebeard kwaye zifuna ingqalelo yezeMpilo ngokukhawuleza ukuba zenzeka iingxaki zokuphefumla. Ihemangiomas kwi-nasal tip (ihemangioma yeCyrano nose) ibeka umngcipheko wokonakaliswa kwe-cartilage engapheliyo kunye nokuphazamiseka kwe-nasal ukuba ingalungiswanga ngexesha lokukhula. Ihemangiomas ezinkulu zobuso, ngakumbi ezi zisebenza kwi-pattern ye-segmental, zingabandakanya i-PHACE syndrome — umjikelo wezinto ezingalunganga kubandakanya i-brain malformations ye-posterior fossa, ihemangioma, i-arhythmic anomalies, i-defects ze-cardiac, kunye neengxaki zomphakathi — ezifuna ukuhlolwa okupheleleyo nge-MRI ye- brain, i-echocardiography, kunye nokuhlolwa kwe-ophthalmologic.
I-ulceration yinto ebonakalayo engxaki yehemangiomas yeentsana, ibonakala kwiimeko ezimalunga neepesenti eziyi-15, ngakumbi kwihemangiomas ezikwiindawo zokuxhaphaza okanye umswakama njengezikhumba, indawo ye-diaper, imikhono ye-neck, kunye ne-axillae. Ihemangiomas ezibulalayo zibangela ubuhlungu obukhulu, umngcipheko we-bacterial infection yesibini, kwaye ziphola ngokwenza i-scarring. Ihemangiomas ezinkulu okanye ezi zisebenza ebusweni ezibangela ukungaphumeleli okukhulu zifuna ukunyango ukuze kuncitshiswe umphumo we-psychosocial kumntwana ophuhlayo.
IPropranolol: Umyalelo Oguqulayo
Uphando lwepropranolol oluphawulekayo ngokuchasene nehemangiomas yeentsana ngo-2008 — umphumo ophosakeleyo xa umntwana ongeniswe kwi-propranolol ngenxa yezizathu ze-cardiac waphumelela kakhulu kwihemangioma — uguqule ulawulo lwehemangiomas ezinzima. Ipropranolol ye-oral, i-beta-adrenergic blocker engakhethiyo eyayisetyenziswa ngaphambili ukunyanga umphunga ophakamileyo kunye nezimo ze-heart, ngoku iyindlela yokuqala yokunyanga ihemangiomas yeentsana ezifuna ukunyanga kwe-systemic. Umthamo ojoliseleyo ngu-2 ukuya ku-3 milligrams ngekilogram ngosuku, uhlukaniswe kwiimveliso ezimbini okanye ezintathu, uqala kwiiveki ezinhlanu zokuphila kwaye uqhubeke de kube malunga neenyanga eziyi-12, nangona ixesha lokunyanga lihluka ngokuxhomekeka kumphumo kunye nomngcipheko wokukhula kwakhona.
Ipropranolol isebenza ngeendlela ezininzi: ibangela ukuvalwa ngokukhawuleza kweemithombo yehemangioma (ebonakalayo njengokuphucuka kunye notshintsho lombala phakathi kweeyure ukuya kwiintsuku zokuqala zokunyanga), ivimba ukuveliswa kwe-vascular endothelial growth factor (VEGF) kunye ne-basic fibroblast growth factor (bFGF) ezikhuthaza ukukhula kwehemangioma, kwaye ibangela i-apoptosis ye-cell endothelial ezikhulayo. Iimpendulo zihlala zikhona, ngaphezu kweepesenti ezingama-95 zehemangiomas ezinyangiweyo zibonisa ukuphucuka okukhulu.!! Iziphumo ezibi ziquka i-hypotension, i-bradycardia, i-hypoglycemia (ikakhulu xa ungena okanye ungekho), i-bronchospasm kwiintsana ezithile, ukuphazamiseka kokulala, kunye neekona ezibandayo.
Ukuqala ukunyanga ngokubanzi kudinga ukugadwa kwezempilo. Ukukhula kwakhona kwenzeka kwiimeko ezimalunga neepesenti eziyi-10 ukuya kweziyi-25 emva kokuyeka, ikakhulu ukuba ukunyanga kuyekwe ngaphambi kweenyanga eziyi-12 zokuphila. I-timolol ye-topical, enye i-beta-blocker, isetyenziswa kwihemangiomas ezincinci, ezithambileyo, eziphezulu, ifakwe ngqo kwi-surface ye-lesion izihlandlo ezimbini ukuya kwezintathu ngosuku kunye nokunciphisa ukungena kwe-systemic kunye nomngcipheko weziphumo ezibi.
Ezinye iindlela zokunyanga kunye neziphumo zexesha elide
Ngaphandle kwepropranolol, iindlela ezininzi zokunyanga zikhona kwihemangiomas yeentsana ngokuxhomekeka kwiimeko ezithile zonyango. I-corticosteroids ye-systemic (prednisolone kwi-2 ukuya kwi-3 milligrams ngekilogram ngosuku) yayiyindlela ejoliseleyo ngaphambi kwepropranolol kwaye isetyenziswa nanamhlanje xa i-beta-blockers zikhankanywe, nangona umphumo weziphumo zazo — kubandakanywa ukunciphisa ukukhula, ukunciphisa umphunga, ukunciphisa i-adrenal, kunye notshintsho lwemood — kwenza kube nzima. I-pulsed dye laser (PDL) therapy ijolise kwi-component ye-vascular ephezulu yehemangiomas kwaye ibaluleke kakhulu kwihemangiomas ezincinci eziphezulu, ihemangiomas eziphezulu, kunye nehemangiomas ezibulalayo (apho iphucula ukuphola kunye nokunciphisa ubuhlungu).
I-surgical excision igcinwe kwihemangiomas ezibangela ukungaphumeleli okungaphenduliyo kwi-therapy yezeMpilo, ukususa i-tissue ye-fibrofatty esele ikhona emva kokuhla, kunye nokwakha ukungaphumeleli kwe-anatomical efana nokuphazamiseka kwe-nasal tip. Ukuhlinzwa ngokubanzi kuhlelwe ukuba kwenzeke emva kokuhla okuphezulu ngaphandle kokuba kudingeka ukungenelela okungxamisekileyo. Ukuze kube neziphumo zexesha elide, abazali kufuneka baqonde ukuba nangona uninzi lwehemangiomas luhla kakhulu, malunga neepesenti ezingama-50 ukuya kweziyi-70 zishiya ezinye iinguqu ezisaseleyo ezibandakanya i-telangiectasias, ukungalingani kwemigca, isikhumba esiphindaphindiweyo, i-fibrofatty residuum, okanye i-scarring evela kwi-ulceration yangaphambili.
Ezi nguqu ezisaseleyo zixhaphakile kwihemangiomas ezinkulu, ezi zibhujiswe, ezinzulu okanye ezixubeneyo, kunye nehemangiomas kwiindawo ezibucayi zokubukeka. Ukunyanga kwangoku ngepropranolol ngexesha lephasi yokukhula kunciphisa kakhulu umthwalo weenguqu ezisaseleyo ngokunciphisa ukukhula kwehemangioma okuphezulu kunye nokukhawulezisa ukuhamba.
Indlela i-AI Skin Analysis Engasiza Ngayo
Xa abazali bejolise kumphumo omtsha obomvu okanye umphumo ophuhlayo kwi-skin yehemangioma, ukungabaza kuyinto eqhelekileyo kwaye iyimfuneko. Ngaba yihemangioma? Ngaba kukho okungaphezulu?
Ngaba kuya kuphumelela? I-Skinscanner ibonelela ngovavanyo olukhawulezayo olusekelwe kwi-AI olungasiza abazali ukuba bazi ukuba i-lesion yesikhumba somntwana ibonisa iimpawu ezihambelana nehemangioma yeentsana okanye ifuna ukuhlolwa kwezeMpilo okungxamisekileyo. Ngokuthatha umfanekiso we-lesion, abazali bafumana uhlalutyo olukhawulezayo lweempawu zayo zokubukeka — umbala, umphumo wombala, umda, kunye nemorphology — kuqhathaniswa neepateni ezijolise kwihemangiomas eziphezulu, ezinzulu, kunye nehemangiomas ezixubeneyo kunye nezinye iimeko ze-vaskhuli ezifuna iindlela ezahlukeneyo zokulawula.
Oku kubaluleke kakhulu kwiiveki zokuqala xa ihemangiomas zikhula ngokukhawuleza kwaye abazali badinga umkhombandlela malunga nokuba utshintsho abajolise kulo luhambelana na nomjikelo ophakathi kokukhula. I-Skinscanner ikwanokunceda ukulandelela ukuhamba kwehemangioma ngokuhamba kwexesha ngokusebenzisa iifoto ezilandelelweyo, ibhalela utshintsho ukusuka ekukhuleni ukuya kwi-plato ukuya ekuhlinzekeni kwaye ikhokela abazali kunye neengcali ukuba bahlolisise ukuba ihemangioma ilandela umjikelo wemvelo obalulekileyo okanye iyahluka ngendlela ebonisa ukuba kudingeka ukungenelela. I-Skinscanner ayifuni ukutshintsha ukuhlolwa kwezingane okanye kwe-dermatologic — nayiphi na i-lesion ye-vaskhuli ekhula ngokukhawuleza kumntwana, ikakhulu edlalayo, kumoya, okanye kwi-pattern ye-segmental, ifuna ukuhlolwa kwezeMpilo ngokukhawuleza. Kodwa ibonelela ngokuqinisekiswa okukhawulezileyo, okukhawulezileyo okanye ukungabaza okufanelekileyo okunceda abazali ukuba benze izigqibo ezichanekileyo malunga nokufuna uncedo lwezeMpilo.
