Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 35174 10.18481/2077-7566-2019-15-4-131-139 СТОМАТОЛОГИЯ ДЕТСКОГО ВОЗРАСТА, ПРОФИЛАКТИКА И ОРТОДОНТИЯ PEDIATRIC DENTISTRY, PROPHILAXIS AND ORTODONTICS СТОМАТОЛОГИЯ ДЕТСКОГО ВОЗРАСТА, ПРОФИЛАКТИКА И ОРТОДОНТИЯ IMPROVEMENT OF APPROACHES TO TREATMENT OF CHILDREN WITH SUPERFICIAL INFANTILE HEMANGIOMAS OF THE HEAD AND NECK USING HIGH-ENERGY LASERS СОВЕРШЕНСТВОВАНИЕ ПОДХОДОВ К ЛЕЧЕНИЮ ДЕТЕЙ С ПОВЕРХНОСТНЫМИ МЛАДЕНЧЕСКИМИ ГЕМАНГИОМАМИ ГОЛОВЫ И ШЕИ С ПРИМЕНЕНИЕМ ВЫСОКОЭНЕРГЕТИЧЕСКИХ ЛАЗЕРОВ Диомидов Илья Андреевич Diomidov Il'ya Andreevich diomidovilya@gmail.com https://orcid.org/0000-0002-8439-3272 Мандра Юлия Владимировна Mandra Yuliya V. jmandra@mail.ru

доктор медицинских наук;

doctor of medical sciences;

 Чернядьев Сергей Александрович Chernyad'ev Sergey Aleksandrovich

доктор медицинских наук;

doctor of medical sciences;

 Жегалина Наталья Максовна Gegalina N. M. nzhegalina@mail.ru

кандидат медицинских наук;

candidate of medical sciences;

 Мандра Екатерина Владимировна Mandra Ekaterina Vladimirovna emandra97@mail.ru Шнейдер Ольга Леонидовна Schneider Olga Leonidovna

кандидат медицинских наук;

candidate of medical sciences;

 Шимова Маргарита Ефимовна Shimova Margarita Efimovna fake@neicon.ru

кандидат медицинских наук;

candidate of medical sciences;

 Димитрова Юлия Викторовна Dimitrova Yulia Viktirovna Duk-74@mail.ru

кандидат медицинских наук;

candidate of medical sciences;

 Болдырев Юрий Анатольевич Boldyrev Yuriy Anatol'evich salus-l@mail.ru

кандидат медицинских наук;

candidate of medical sciences;

 Уральский государственный медицинский университет Ural State Medical University Уральский государственный медицинский университет Екатеринбург Россия Ural State Medical University Yekaterinburg Russian Federation Уральский государственный медицинский университет Екатеринбург Россия Уральский государственный медицинский университет Екатеринбург Russian Federation Первый Московский государственный медицинский университет имени И.М. Сеченова I.M. Sechenov First Moscow State Medical University 28 12 2019 28 12 2019 15 4 131 139 03 12 2019 10 12 2019 https://dental-press.ru/en/nauka/article/35174/view

Предмет. Гемангиомы кожных покровов и слизистых, относящиеся к группе сосудистых аномалий, составляют около 50 % среди прочих опухолей мягких тканей у детей. Одним из методов лечения, способных обеспечить как радикальное избавление от поверхностных гемангиом, так и оставление малозаметного следа, является лазерное воздействие — лазерокоагуляция. Цель — повысить эффективность лечения детей с поверхностными младенческими гемангиомами головы и шеи путем обоснования дифференцированного подбора высокоэнергетического лазера. Методология. Всего в исследование было включено 512 детей. Общий массив материала в соответствии с задачами исследования был разделен на четыре части: оценка отдаленных результатов лечения младенческих гемангиом; сравнительное исследование эффективности двух лазерных систем при лечении младенческих гемангиом с разной степенью возвышения над окружающей кожей; оценка эстетической эффективности использования лазерных технологий на фоне модернизации метода охлаждения при лечении младенческих гемангиом лица и шеи у детей; изучение социальной эффективности протокола выбора метода лечения при младенческих гемангиомах головы и шеи у детей. Результаты. Полученная статистически достоверная разница изменений по всем шкалам между двумя группами математически подтвердила то, что модернизированный подход дает возможность получить более высокую социальную эффективность лечения, по всей видимости, за счет большей эстетичности остающихся рубцов после лечения. Выводы. Обнаружена выраженная разница в реакции гемангиом на различные типы лазеров: сочетание лазерокоагуляции с постоянным водным охлаждением более эстетически эффективно, чем применение периодических аппликаций льда; социальная эффективность подхода с использованием протокола выбора тактики лечения выше, чем при стандартных подходах.

Background. Hemangiomas of the skin and mucous membranes, which belong to the group of vascular abnormalities, make up about 50% among other soft tissue tumors in children. Laser coagulation is one of the treatment methods that can provide both a radical removal of superficial hemangiomas and leaving an imperceptible trace. The goal is to increase the effectiveness of treatment of children with superficial infant hemangiomas of the head and neck by substantiating the differentiated selection of a high-energy laser. Methodology. A total of 512 children were included in the study. In accordance with the tasks of the study, the total body of material was divided into four parts: evaluation of the long-term results of the treatment of infant hemangiomas; a comparative study of the effectiveness of two laser systems in the treatment of infantile hemangiomas with varying degrees of elevation over the surrounding skin; assessment of the aesthetic efficiency of using laser technologies against the background of the modernization of the cooling method in the treatment of infantile hemangiomas of the face and neck in children; the study of the social effectiveness of the protocol for choosing a method of treatment of infantile hemangiomas of the head and neck in children. Results. The obtained statistically significant difference in changes on all scales between the two groups mathematically confirmed that the modernized approach makes it possible to obtain higher social effectiveness of the treatment, apparently due to the greater aesthetics of the remaining scars after treatment. Conclusions. A pronounced difference was found in the response of hemangiomas to various types of lasers, the combination of laser-coagulation with constant water cooling has a greater aesthetic effectiveness than the use of periodic ice applications, the social effectiveness of the approach using the protocol for choosing treatment tactics is higher than with standard approaches.

 младенческие гемангиомы лазерокоагуляция гемангиом эстетическая оценка рубцов после гемангиом социальная эффективность лечения гемангиом infant hemangiomas laser coagulation of hemangiomas aesthetic assessment of scars after hemangiomas social effectiveness of hemangiomas treatment

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