asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2019-1-2-64-71asurgery-139Research ArticleЭСТЕТИЧЕСКАЯ ФЛЕБОЛОГИЯAESTHETIC PHLEBOLOGYОсобенности лазерной коагуляции «винных пятен» (случаи из практики)Features of laser coagulation of «port-wine stains» (cases from practice)БелянинаЕ. О.BelyaninaE. O.

Белянина Елена Олеговна – кандидат медицинских наук, врач хирург-онколог, дерматокосметолог.

109028, Москва, пер. Подсосенский, д. 20а; тел.: +7 (495) 120-06-10.

Belyanina Elena Olegovna – Candidate of Medical Sciences, surgeon-oncologist, dermatocosmetologist.

109028. 20a Podsosenskylane, Moscow; tel.: +7 (495) 120-06-10.

e230@bk.ruFRAU KLINIK «Клиника пластической хирургии и косметологии профессора Блохина С.Н. и доктора Вульфа И.А.»РоссияFRAU KLINIK «Clinic of Plastic Surgery and Cosmetology of Professor Blokhin S.N. and Dr. Wolf I. ARussian Federation20191204201901-26471Copyright © Белянина Е.О., 20192019Белянина Е.О.Belyanina E.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/139

Чрескожная лазерная  коагуляция (селективный фототермолиз) в настоящее время является «золотым стандартом» лечения «винных пятен». Однако достичь полного удаления сосудистого поражения удается крайне редко, а в 20% случаев отмечена резистентность к лазерному воздействию.

В статье приводятся клинические случаи лечения «винных пятен» у двух пациентов. На основе собственного опыта и данных литературы проведен анализ результатов лечения, побочных эффектов применения лазеров, а также рассмотрены альтернативные перспективные  методы лечения.

Percutaneous laser  coagulation (selective photothermolysis) is currently  the  «gold  standard» for the  treatment of «port-wine stains». However, complete removal of the vascular lesion is rarely possible,  and in 20% of cases there is resistance to laser attack. The article  presents clinical cases of «port-wine stains» treatment in two patients. On the basis of own experience and literature data the analysis of treatment results, side effects  of lasers application was carried out, and also alternative perspective methods of treatment were considered.

капиллярная ангиодисплазиявинное пятночрескожная лазерная коагуляцияклинический примерэстетическая коррекциясимптоматическое лечениеcapillary angiodisplasiaport-wine stainpercutaneous laser coagulationclinical exampleaesthetic correctionsymptomatic treatmentReferencesДан В.Н., Сапелкин С.В. Ангиодисплазии (врожденные пороки развития сосудов). М.: Вердана, 2008.Dan V.N., Sapelkin S.V., Angiodisplasia (congenital vascular malformations). Moscow: Verdana, 2008.Mulliken J.B., Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69:412–422.Mulliken J.B., Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69:412–422.Enjolras O. Vascular malformations. In: Bolognia J.L., Jorizzo J.L., Rapini R.P. et al. Dermatology. London: Mosby; 2003:1615–1629.Enjolras O. Vascular malformations. In: Bolognia J.L., Jorizzo J.L., Rapini R.P. et al. Dermatology. London: Mosby; 2003:1615–1629.Мишнев О.Д., Павлов К.А., Дубова Е.А., Щеголев А.И. Ангиодисплазии (сосудистые мальформации): Пособие для врачей. М.: Издательство РГМУ, 2008. 44 с.Mishnev O.D., Pavlov K.A., Dubova E.A., Shchegolev A.I. (vascular malformations): Manual for doctors. M.: Russian State Medical University Publishing House, 2008. 44 p. (In Russ.)Бокерия Л.А., Морозов К.М., Серов Р.А., Ронами В.Г. Гемангиомы и сосудистые мальформации: классификация, клиника, диагностика, лечение, ошибки (на примере клинического наблюдения). Анналы хирургии. 2008;6:76–80.Boqueria L.A., Morozov K.M., Serov R.A., Ronami V.G. Gemangioma and vascular malformations: classification, clinic, diagnostics, treatment, errors (on the example of clinical observation). Surgical annals. [Annaly hirurgii] 2008;6:76–80. (In Russ.)Adamic M., Troilius A., Adatto M., Drosner M., Dahmane R. Vascularlasers and IPLs: Guidelines for care from the European Society for Laser Dermatology (ESLD). J Cosmet Laser Ther. 2007;9:113–124.Adamic M., Troilius A., Adatto M., Drosner M., Dahmane R. Vascularlasers and IPLs: Guidelines for care from the European Society for Laser Dermatology (ESLD). J Cosmet Laser Ther. 2007;9:113–124.Hagen S.L., Grey K.R. et al. Quality oflife in adults with facial port-wine stains. J Am Acad Dermatol. 2017;76 (4):695–702.Hagen S.L., Grey K.R. et al. Quality oflife in adults with facial port-wine stains. J Am Acad Dermatol. 2017;76 (4):695–702.Landthaler M., Hohenleutner U. Laser therapy of vascularlesions. Photodermatol Photoimmunol Photomed. 2006;22:324–332.Landthaler M., Hohenleutner U. Laser therapy of vascularlesions. Photodermatol Photoimmunol Photomed. 2006;22:324–332.Stier M.F., Glick S.A., Hirsch R.J. Laser Treatment of pediatric vascularlesions: port wine stains and hemangiomas. Am Acad Dermatol. 2008;58:261–285.Stier M.F., Glick S.A., Hirsch R.J. Laser Treatment of pediatric vascularlesions: port wine stains and hemangiomas. Am Acad Dermatol. 2008;58:261–285.Woo S., Ahn H.H., Kim S.N., Kye Y.C. Treatment of vascular skin lesions with the variable-pulse 595 nm pulsed dyelaser. Dermatol Surg. 2006;32:41–48.Woo S., Ahn H.H., Kim S.N., Kye Y.C. Treatment of vascular skin lesions with the variable-pulse 595 nm pulsed dyelaser. Dermatol Surg. 2006;32:41–48.Greve B., Raulin C. Prospective study of port wine stain treatment with dyelaser: comparison of two wavelengths (585 nm vs 595 nm) and two pules durations (0,5 milliseconds vs 20 milliseconds). Lasers Surg Med. 2004;34:168–173.Greve B., Raulin C. Prospective study of port wine stain treatment with dyelaser: comparison of two wavelengths (585 nm vs 595 nm) and two pules durations (0,5 milliseconds vs 20 milliseconds). Lasers Surg Med. 2004;34:168–173.Eubanks L.E., McBurney E.I. Videomicroscopy of port-wine stains: Correlation oflocation and depth oflesion. J Am Acad Dermatol. 2001;44:948–951.Eubanks L.E., McBurney E.I. Videomicroscopy of port-wine stains: Correlation oflocation and depth oflesion. J Am Acad Dermatol. 2001;44:948–951.Renfro L., Geronemus R.G. Anatomical differences of port wine stains in response to treatment with pulsed dyelaser. Arch Dermatol. 1993;129:182–188.Renfro L., Geronemus R.G. Anatomical differences of port wine stains in response to treatment with pulsed dyelaser. Arch Dermatol. 1993;129:182–188.Jasim Z.F., Handley J.M. Treatment of pulsed dyelaser – resistant port wine stain birthmarks. J Am Acad Dermatol. 2007;57:677–682.Jasim Z.F., Handley J.M. Treatment of pulsed dyelaser – resistant port wine stain birthmarks. J Am Acad Dermatol. 2007;57:677–682.Yu W., Ma G., Qiu Y. et al. Why do port-wine stains (PWS) on the lateral face respond better to pulsed dyelaser (PDL) than those located on the central face? J Am Acad Dermatol. 2016;74:527–535.Yu W., Ma G., Qiu Y. et al. Why do port-wine stains (PWS) on the lateral face respond better to pulsed dyelaser (PDL) than those located on the central face? J Am Acad Dermatol. 2016;74:527–535.Ackermann G., Hartmann M., Scherer K. et al. Correlations betweenlight penetration into skin and the therapeutic outcome followinglaser therapy of port-wine stains. Lasers Med Sci. 2002;17:70–78.Ackermann G., Hartmann M., Scherer K. et al. Correlations betweenlight penetration into skin and the therapeutic outcome followinglaser therapy of port-wine stains. Lasers Med Sci. 2002;17:70–78.Burns A.J., Navarro J.A. Role of laser therapy in pediatric patients. Plast Reconstr Surg. 2009;124 (Suppl):82–92.Burns A.J., Navarro J.A. Role of laser therapy in pediatric patients. Plast Reconstr Surg. 2009;124 (Suppl):82–92.Reyes B.A., Geronemus R. Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser. J Am Acad Dermatol. 1990;23:1142–1148.Reyes B.A., Geronemus R. Treatment of port-wine stains during childhood with the flashlamp-pumped pulsed dye laser. J Am Acad Dermatol. 1990;23:1142–1148.Cantatore J.L., Kriegel D.A. Laser surgery: an approach to the pediatric patient. J Am Acad Dermatol. 2004;50:165–184.Cantatore J.L., Kriegel D.A. Laser surgery: an approach to the pediatric patient. J Am Acad Dermatol. 2004;50:165–184.Wenxin Yu., Jiafang Zh. et al. Port-wine stains on the neck respond better to a pulsed dye laser than lesions on the face: An intrapatient comparison study with histopathology. J.Am. Acad. Derm. 2019;80 (30):779–781.Wenxin Yu., Jiafang Zh. et al. Port-wine stains on the neck respond better to a pulsed dye laser than lesions on the face: An intrapatient comparison study with histopathology. J.Am. Acad. Derm. 2019;80 (30):779–781.Lorenz S., Scherer K., Wimmershoff M.B., Landthaler M., Hohenleutner U. Variable pulse frequency-doubled Nd:YAG laser versus flashlamp-pumped dye laser in the treatment of port wine stains. Acta Derm Venerol. 2003;83:210–213.Lorenz S., Scherer K., Wimmershoff M.B., Landthaler M., Hohenleutner U. Variable pulse frequency-doubled Nd:YAG laser versus flashlamp-pumped dye laser in the treatment of port wine stains. Acta Derm Venerol. 2003;83:210–213.Chan H.H., Chan E., Kono T. et al. The use of variable pulse width frequency doubled Nd:YAG 532 nm laser in the treatment of port-wine stain in Chinese patients. Dermatol Surg. 2000;26:657–661.Chan H.H., Chan E., Kono T. et al. The use of variable pulse width frequency doubled Nd:YAG 532 nm laser in the treatment of port-wine stain in Chinese patients. Dermatol Surg. 2000;26:657–661.Faurschou A., Togsverd-Bo K., Zachariae C., Haedersdal M. Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation. Br J Dermatol. 2009;160 (2):359–364.Faurschou A., Togsverd-Bo K., Zachariae C., Haedersdal M. Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation. Br J Dermatol. 2009;160 (2):359–364.Ho W.S., Ying S.Y., Chan P.C., Chan H.H. Treatment of port wine stains with Intense Pulsed Light: a prospective study. Dermatol Surg. 2004;30:887–891.Ho W.S., Ying S.Y., Chan P.C., Chan H.H. Treatment of port wine stains with Intense Pulsed Light: a prospective study. Dermatol Surg. 2004;30:887–891.Bjerring P., Christiansen K., Troilius A. Intense pulsedlight source for the treatment of dyelaser resistant port-wine stains. J Cosmet Laser Ther. 2003;5 (1):7–13.Bjerring P., Christiansen K., Troilius A. Intense pulsedlight source for the treatment of dyelaser resistant port-wine stains. J Cosmet Laser Ther. 2003;5 (1):7–13.Yang M.U., Yaroslavsky A.N., Farinelli W.A. et al. Longpulsed neodymium: yttrium-aluminum-garnetlaser treatment for portwine stains. J Am Acad Dermatol. 2005;52:480–490.Yang M.U., Yaroslavsky A.N., Farinelli W.A. et al. Longpulsed neodymium: yttrium-aluminum-garnetlaser treatment for portwine stains. J Am Acad Dermatol. 2005;52:480–490.Izikson L., Nelson J.S., Anderson R.R. Treatment of hypertrophic and resistant port wine stains with a 755 nmlaser: a case series of 20 patient. Lasers Surg Med. 2009;41 (6):427–32.Izikson L., Nelson J.S., Anderson R.R. Treatment of hypertrophic and resistant port wine stains with a 755 nmlaser: a case series of 20 patient. Lasers Surg Med. 2009;41 (6):427–32.Chapas A.M., Eickhorst K., Geronemus R.G. Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases. Lasers Surg Med. 2007;39:563–568.Chapas A.M., Eickhorst K., Geronemus R.G. Efficacy of early treatment of facial port wine stains in newborns: a review of 49 cases. Lasers Surg Med. 2007;39:563–568.Geronemus R.G. Long-pulsed neodymium:yttrium-aluminum-garnetlaser treatment for port wine stains. J Am Acad Dermatol. 2006;54:923.Geronemus R.G. Long-pulsed neodymium:yttrium-aluminum-garnetlaser treatment for port wine stains. J Am Acad Dermatol. 2006;54:923.Alster T.S., Tanzi E.L. Combined 595-nm and 1,064-nmlaser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults. Dermatol Surg. 2009;35:914–918.Alster T.S., Tanzi E.L. Combined 595-nm and 1,064-nmlaser irradiation of recalcitrant and hypertrophic port-wine stains in children and adults. Dermatol Surg. 2009;35:914–918.Ozdemir M., Engin B., Mevlitoglu I. Treatment of facial port-wine stains with intense pulsedlight: a prospective study. J Cosmet Dermatol. 2008;7 (2):127–131.Ozdemir M., Engin B., Mevlitoglu I. Treatment of facial port-wine stains with intense pulsedlight: a prospective study. J Cosmet Dermatol. 2008;7 (2):127–131.Orten S., Waner M., Flock S., Roberson P., Kincannon J. Port-wine stains. An assessment of 5 years of treatment. Arch Otolaryngol Head Neck Surg. 1996;122:1174–1179.Orten S., Waner M., Flock S., Roberson P., Kincannon J. Port-wine stains. An assessment of 5 years of treatment. Arch Otolaryngol Head Neck Surg. 1996;122:1174–1179.Michel S., Landthaler M., Hohenleutner U. Recurrence of portwine stains after treatment with the flashlamp-pumped pulsed dyelaser. Br J Dermatol. 2000;143:1230–1234.Michel S., Landthaler M., Hohenleutner U. Recurrence of portwine stains after treatment with the flashlamp-pumped pulsed dyelaser. Br J Dermatol. 2000;143:1230–1234.Huikeshoven M., Koster P., de Borgie C. et al. Redarkening of port-wine stain 10 years after pulsed-dyelaser treatment. N Engl J Med. 2007;356:1235–1240.Huikeshoven M., Koster P., de Borgie C. et al. Redarkening of port-wine stain 10 years after pulsed-dyelaser treatment. N Engl J Med. 2007;356:1235–1240.Коспанов Н.А., Азимбаев Г.С., Юхневич Е.А. Врожденные ангиодисплазии. Клинические протоколы Министерства здравоохранения Республики Казахстан. 2015.Kospanov N.A., Azimbayev G.S., Yukhnevich E.A. Congenital angiodisplasia. Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan. 2015. (In Russ.)Ozluer S.M., Barlow R.J. Partial re-emergence of port-wine stain following successful treatment with flashlamp-pumped dyelaser. Clin Exp Dermatol. 2001;26:37–39.Ozluer S.M., Barlow R.J. Partial re-emergence of port-wine stain following successful treatment with flashlamp-pumped dyelaser. Clin Exp Dermatol. 2001;26:37–39.Willey А., Anderson R., Azpiazu J.L. et al. Complications of laser dermatologic surgery. Lasers in Surgery and Medicine. 2006;38:1–15.Willey А., Anderson R., Azpiazu J.L. et al. Complications of laser dermatologic surgery. Lasers in Surgery and Medicine. 2006;38:1–15.Chapas A.M., Fazeli A., Goldberg D., Geronimus R. Sequential, dual wavelength treatment of port wine birthmarks: pilot study [abstract]. Lasers Surg Med. 2006; Suppl:18–21.Chapas A.M., Fazeli A., Goldberg D., Geronimus R. Sequential, dual wavelength treatment of port wine birthmarks: pilot study [abstract]. Lasers Surg Med. 2006; Suppl:18–21.Bae Y.C., Alabdulrazzaq H., Brauer J.A., Geronemus R.G. Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dyelaser (PDL) and radiofrequency (RF) energy device. J Am Acad Dermatol. 2017;76:321–326.Bae Y.C., Alabdulrazzaq H., Brauer J.A., Geronemus R.G. Treatment of recalcitrant port-wine stains (PWS) using a combined pulsed dyelaser (PDL) and radiofrequency (RF) energy device. J Am Acad Dermatol. 2017;76:321–326.Tremaine A.M., Armstrong J., Huang Y. et al. Enhanced port-wine stainlightening achieved with combined treatment of selective photothermolysis and imiquimod. J Am Acad Dermatol. 2012;66:632–641.Tremaine A.M., Armstrong J., Huang Y. et al. Enhanced port-wine stainlightening achieved with combined treatment of selective photothermolysis and imiquimod. J Am Acad Dermatol. 2012;66:632–641.Chen J.K., Ghasri P., Aguilar G. et al. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol. 2012;67:289–304.Chen J.K., Ghasri P., Aguilar G. et al. An overview of clinical and experimental treatment modalities for port wine stains. J Am Acad Dermatol. 2012;67:289–304.

The authors declare that there are no conflicts of interest present.