Hemangioma: Ukuqonda Izimpawu Zokuzalwa Zezitho Zomzimba Kwezingane

I-hemangioma yezingane (IH) iyithumba lezakhamzimba elingelapheki elakhiwe ngamaseli e-endothelial akhula ngokushesha — la maseli ahlukanisa imithambo yegazi. Iyi-thumba evamile kakhulu ebuntwaneni, ithinta cishe u-4 kuya ku-10 percent wabantwana baseCaucasian, kanti incazelo yayo iphansi kubantu base-Asia nase-Afrika. Ama-hemangiomas avame kakhulu emantombazaneni kunamabhuku, futhi abantwana abaphuma ngaphambi kwesikhathi nalabo abanezinga lokuzalwa eliphansi bahlala besengozini enkulu.

Lezi zindawo zivame ukuvela phakathi nezinsuku zokuqala zokuphila, ngokuvamile ziqala ngophawu olukhanyayo noma oluncane olukhanyayo olukhona ngesikhathi sokuzalwa. Ama-hemangiomas angavela noma kuphi emzimbeni kodwa avame kakhulu ekhanda nasemzimbeni, abamba u-60 percent wezimo. Ahlelwa ngokujulile: ama-hemangiomas aphansi ahlanganisa kuphela i-dermis ephezulu futhi avele njengamathumba abomvu, aphakeme, anemigqa (i-hemangioma ye-strawberry); ama-hemangiomas ajulile ahlala kwi-dermis ephansi nasemathunjini, ebonakala njengokukhanya okuphakathi, okungabhalwa ngaphansi kwesikhumba esiqinile; futhi ama-hemangiomas ahlanganisa kokubili izici eziphezulu nezijulile.

Usayizi uhleleka kusuka kumamilimitha ambalwa kuya kumacentimeter amaningi, futhi nakuba iningi lihlala lidlalwa, cishe u-15 kuya ku-20 percent wabantwana abathintekayo banezithombe eziningi ze-hemangiomas. Naphezu kokubukeka kwazo okukhulu nokukhula okusheshayo, iningi elikhulu lama-hemangiomas yezingane alinasidingo sezokwelapha futhi alandela umjikelezo ojwayelekile wokukhula, ukuvikeleka, nokuhamba phambili.

Ukuqonda umlando wemvelo we-hemangiomas yezingane kubalulekile ukuze kuqondiswe kahle, njengoba lezi zithumba zilandela umjikelezo ophawulekayo oqukethe izigaba ezintathu ezihlukene. Izigaba zokukhula (growth) ziqala ezinsukwini zokuqala zokuphila futhi zihlukaniswa ngokukhula okusheshayo kwe-hemangioma. Ukukhula okuningi kwenzeka phakathi kwezinyanga ezintathu kuya kwezihlanu zokuqala, lapho u-80 percent wosayizi omkhulu uvame ukufinyelelwa ezinyangeni ezintathu zokuphila.

Ngesikhathi salolu suku, ama-hemangiomas aphansi aba abomvu, aphakeme, futhi anemigqa, kanti ama-hemangiomas ajulile akhula njengamathumba abomvu, aphakeme. Ukukhula kungaba yingozi kubazali — iphuzu elincane elibomvu lingakhula libe ngamacentimeter amaningi ezinsukwini — kodwa lezi zigaba zokukhula zikhawulelwe. Izigaba ze-plato zilandela, ngokuvamile ziqala cishe ezinyangeni eziyisithupha kuya kwezingu-9 zokuphila, lapho i-hemangioma iyeka ukukhula futhi ihlala iqinile.

Umbala ungase uqale ukujula usuka ebomvu ukuya kumnyama okuncane. Lezi zigaba zingahlala izinyanga. Izigaba zokuhamba phambili (involution) zihlukanisa ama-hemangiomas yezingane kwezinye izinkinga zezakhamzimba.

Ukuhamba phambili okuzenzakalelayo kuqala njengoba amaseli e-endothelial edlula kwi-apoptosis futhi kancane kancane abuyiselwa ngamaseli e-fibrofatty. Umbala uyashintsha usuka ebomvu uze ube mhlophe noma ophuzi, futhi umthamo unciphisa kancane. Ukuhamba phambili kwenzeka ngesilinganiso esilinganiselwa ku-10 percent ngonyaka — ngonyaka wesihlanu, u-50 percent wokuhamba phambili uqediwe; ngonyaka wesixhenxe, u-70 percent; futhi ngonyaka wesishiyagalombili kuya kwesishiyagalolunye, iningi lama-hemangiomas sehlile ngokuphelele. Nokho, ukuhamba phambili okuphelele akusho ukuthi ukubuyiselwa kwezakhamzimba kuphelele: izinguquko ezisele ezifana ne-telangiectasias, ama-masses e-fibrofatty, isikhumba esiphindaphindiwe, noma izilonda (ikakhulukazi uma i-hemangioma ibonakale) zingahlala zikhona futhi zidinga ukwelashwa kwezakhamzimba.

Ngenkathi iningi lama-hemangiomas yezingane lingelapheki futhi lihlala lihlala, cishe u-10 kuya ku-15 percent kudinga ukwelashwa okusebenzayo ngenxa yesikhundla sawo, usayizi, noma izinkinga. Ama-hemangiomas aphazamisa umgudu wombono — ama-hemangiomas e-periorbital aphazamisa ukubona noma adala i-astigmatism ngokucindezela emehlweni akhula — adinga ukungenelela ngokuphuthumayo ngoba ukungabi nombono ngesikhathi esibalulekile sokuthuthukiswa kokubona kungadala i-amblyopia (amehlo alahlekile) okungapheli.!! Ama-hemangiomas emoyeni, ikakhulukazi ama-hemangiomas e-subglottic kwi-trachea, angadala i-stridor eqhubekayo, ubunzima bokuphefumula, nokuvinjelwa komoya okungaba yingozi empilweni.

Lezi zivame ukuhlotshaniswa nama-hemangiomas e-segmental cutaneous endaweni yokukhula kwesitho sokukhuluma futhi zidinga ukunakekelwa kwezokwelapha ngokuphuthumayo uma ubunzima bokuphefumula buvela. Ama-hemangiomas ethanga (i-hemangioma ye-Cyrano nose) abeka engcupheni yokubhujiswa kwe-cartilage okungapheli nokuphazamiseka kokuphefumula uma engalashwa ngesikhathi sokukhula. Ama-hemangiomas amakhulu ebusweni, ikakhulukazi lawo akhula ngendlela ye-segmental, angahlotshaniswa ne-PHACE syndrome — ukuhlanganiswa kwezinkinga ezihlanganisa ukungahambi kahle kwe-brain fossa, i-hemangioma, izinkinga zemithambo, izinkinga zenhliziyo, nezinkinga zokubona — kudinga ukuhlolwa okuphelele nge-MRI ye-brain, i-echocardiography, kanye nokuhlolwa kwezokubona.

Ukuhluka kuyinkinga evamile ye-hemangiomas yezingane, kwenzeka cishe ku-15 percent wezimo, ikakhulukazi kuma-hemangiomas atholakala ezindaweni zokuphazamiseka noma umswakama njengezindebe, endaweni ye-diaper, emathunjini, nasemathanjeni. Ama-hemangiomas ahlukanisiwe adala ubuhlungu obukhulu, ubungozi bokungena kokutheleleka kwe-bacterial, futhi aphola ngokushiya izilonda. Ama-hemangiomas amakhulu noma lawo ebusweni adala ukuphazamiseka okukhulu nakho kudinga ukwelashwa ukuze kuncishiswe umthelela wezokwenziwa kumntwana okhula.

Ukutholwa kokusebenza okuhle kwe-propranolol ngokumelene nama-hemangiomas yezingane ngo-2008 — ukutholwa okungazelelwe ngesikhathi ingane elashwa nge-propranolol ngenxa yezizathu zenhliziyo yathola ukuhamba phambili okukhulu kwe-hemangioma — kwaguqula ukuphathwa kwama-hemangiomas abhekene nezinkinga. I-propranolol ye-oral, i-beta-adrenergic blocker engakhethwa ngaphambilini eyasetshenziswa ukwelapha ukucindezela kwegazi okuphezulu nezinkinga zenhliziyo, manje iyindlela yokuqala yokwelashwa kwama-hemangiomas yezingane adinga ukwelashwa okujwayelekile. I-dosi ejwayelekile ingama-miligram amabili kuya kwamathathu ngekilogram ngosuku, ihlukaniswe ibe yiziguli ezimbili noma ezintathu, iqala ngemuva kwezinyanga ezinhlanu zokuphila futhi iqhubeke kuze kube yizinyanga eziyi-12, nakuba isikhathi sokwelashwa sishintsha ngokuya ngempendulo nasezinkingeni zokukhula kabusha.

I-propranolol isebenza ngezindlela eziningi: idala ukuvinjwa kwemithambo yegazi ye-hemangioma (okubonakala njengokuthambekela nokushintsha kombala phakathi kwamahora kuya ezinsukwini zokwethulwa), ivimbela ukuvezwa kwe-vascular endothelial growth factor (VEGF) kanye ne-basic fibroblast growth factor (bFGF) ezikhuthaza ukukhula kwe-hemangioma, futhi ibangela i-apoptosis yamaseli e-endothelial akhulayo. Izinga lokuphendula lihle, ngaphezu kuka-95 percent wama-hemangiomas alashwe ebonisa ukuthuthuka okukhulu.!! Imiphumela emibi ihlanganisa i-hypotension, i-bradycardia, i-hypoglycemia (ikakhulukazi uma kudla noma uma kunesifo), i-bronchospasm ezincane ezithintekayo, ukuphazamiseka kokulala, kanye nezitho ezibandayo.

Ukuqala kokwelashwa kuvame ukufuna ukuqapha kwezokwelapha. Ukukhula kabusha kwenzeka cishe ku-10 kuya ku-25 percent wezimo ngemuva kokumiswa, ikakhulukazi uma ukwelashwa kumiswa ngaphambi kwezinyanga eziyi-12 zokuphila. I-timolol ye-topical, enye i-beta-blocker, isetshenziswa kuma-hemangiomas amancane, thin, aphansi, ifakwe ngqo ebusweni bezindawo ezimbili kuya kwezintathu ngosuku ngokunciphisa ukujula nokuphazamiseka kwemiphumela emibi.

Ngaphandle kwe-propranolol, kunezinye izindlela zokwelashwa ezitholakalayo zama-hemangiomas yezingane kuye ngezimo ezithile zokwelapha. Ama-corticosteroids ajwayelekile (prednisolone ngama-miligram amabili kuya kwamathathu ngekilogram ngosuku) ayewumjikelezo ojwayelekile ngaphambi kwe-propranolol futhi asasetshenziswa lapho ama-beta-blockers engafaneleki, nakuba iphrofayili yemiphumela emibi — kuhlanganisa ukuvinjwa kokukhula, ukuvinjwa kokuvikela, ukuvinjwa kwe-adrenal, kanye nezinguquko zomoya — kwenza kube nzima. I-pulsed dye laser (PDL) ithinta ingxenye ye-vascular ephansi ye-hemangiomas futhi ibalulekile ekwelapheni i-telangiectasias esele ngemuva kokuhamba phambili, ama-hemangiomas aphansi, kanye nama-hemangiomas ahlukanisiwe (lapho ikhulisa ukuphola nokunciphisa ubuhlungu).

Ukuhlukaniswa kokuhlinzwa kugcinwe kuma-hemangiomas adala ukuphazamiseka kokusebenza okungaphenduli ekwelapheni, ukususa izicubu ze-fibrofatty ezisele ngemuva kokuhamba phambili, kanye nokwakha ukungahambi kahle kwezitho ezifana nokuphazamiseka kokuthanga. Ukuhlinzwa kuvame ukubambezeleka kuze kube sekupheleni kokuhamba phambili okukhulu ngaphandle uma kudingeka ukungenelela ngokuphuthumayo. Ngemiphumela yesikhathi eside, abazali kufanele baqonde ukuthi nakuba iningi lama-hemangiomas lihamba phambili kakhulu, cishe u-50 kuya ku-70 percent kushiya ezinye izinguquko ezisele ezikhangayo ezingase zifake i-telangiectasias, ukungahambi kahle kokwakheka, isikhumba esiphindaphindiwe, i-fibrofatty residuum, noma izilonda ezivela ekuhlukanisweni.

Lezi zinguquko ezisele zenzeka kakhulu kuma-hemangiomas amakhulu, lawo ahlukanisiwe, ajulile noma ahlanganisiwe, kanye nama-hemangiomas ezindaweni ezibucayi zokwakheka. Ukwelashwa kwanamuhla nge-propranolol ngesikhathi sezigaba zokukhula kunciphisa kakhulu umthwalo wezinguquko ezisele ngokunciphisa ukukhula okukhulu kwe-hemangioma nokusheshisa ukuhamba phambili.

Lapho abazali beqaphela uphawu olusha olubomvu noma umphumela okhulayo esikhumbeni sezingane zabo, ukukhathazeka kuyinto ejwayelekile futhi esheshayo. Ingabe kuyisikhumba esinokukhanya? Ingabe kukhona okungaphezulu?

Kuzophela? I-Skinscanner inikeza ukuhlaziywa okusheshayo okusekelwe ku-AI okungasiza abazali ukuthi bazi ukuthi ingabe isikhumba sezingane zabo sinezici ezihambisana nesikhumba esinokukhanya noma kudinga ukuhlolwa kwezokwelapha okuphuthumayo. Ngokuvula isithombe sesikhumba, abazali bathola ukuhlaziywa okusheshayo kwezici zaso ezibonakalayo — umbala, ubukhulu besurface, ukucaciswa kwemingcele, kanye nemorphology — kuqhathaniswa nezithombe ezijwayelekile zehemangiomas eziphezulu, ezijulile, nezihlanganisiwe kanye nezinye izinkinga ze-vascular ezidinga izindlela ezihlukile zokuphatha.

Lokhu kubalulekile ikakhulukazi ezinsukwini zokuqala lapho amahemangiomas ekhula ngokushesha futhi abazali badinga umhlahlandlela wokuthi ingabe izinguquko abazibona zikhona ngaphakathi kwesikhala sokukhula esilindelekile. I-Skinscanner ingasiza futhi ukulandelela ukuhamba phambili kwehemangioma ngokuhamba kwesikhathi ngezithombe ezilandelanayo, ibhalela ushintsho ukusuka ekukhuleni kuya ekuphumuleni nasekuphendukeni, futhi isize abazali nabadokotela ukuthi bahlaziye ukuthi ingabe ihemangioma ilandela indlela yokukhula evamile noma iyashintsha ngezindlela ezibonisa ukuthi kudingeka ukungenelela. I-Skinscanner ayithathi indawo yokuhlola yezingane noma yokwelapha isikhumba — noma yisiphi isikhumba esikhulayo ngokushesha esingane, ikakhulukazi eduze kwamehlo, emoyeni, noma ngendlela yesigaba, sidinga ukuhlolwa kwezobuchwepheshe ngokushesha. Kodwa inikeza ukuqinisekiswa okutholakalayo, okusheshayo noma ukukhathazeka okufanele okwenza abazali benze izinqumo ezihlakaniphile mayelana nokufuna usizo lwezokwelapha.