普萘洛尔联合局部硬化治疗≤5个月儿童大型血管瘤的临床疗效及并发症研究

doi:10.3877/cma.j.issn.2095-5782.2017.04.004

目的：

研究口服普萘洛尔联合局部硬化治疗儿童大型血管瘤的临床疗效以及并发症发生情况。

方法：

选取2013年1月—2016年4月我院收治的年龄≤5个月的大型血管瘤患儿237例，分为两组。单纯治疗组86例采用单纯局部硬化治疗：在DSA或B超引导下，对瘤体采用多点穿刺，回抽见血后，将硬化剂缓慢注入瘤体组织中，至瘤体肿胀或变苍白为度。联合治疗组151例，口服普萘洛尔联合局部硬化治疗：24 h长程心电图正常后第2天始给予普萘洛尔口服，同时行局部硬化治疗，随访3个月~1.5年后，比较两组临床疗效及并发症的发生情况。

结果：

联合治疗组的总有效率96.7%（146/151）高于单纯治疗组89.5%（77/86），差异有统计学意义（χ²=5.045，P<0.05）。且联合治疗组的治愈率71.5%（108/151）也高于单纯治疗组47.7%（41/86），差异有统计学意义（χ²=13.350，P<0.01）。联合治疗组的并发症发生率25.8%（39/151）低于单纯治疗组38.4%（33/86），差异有统计学意义（χ²=4.077，P<0.05）。

结论：

口服普萘洛尔联合局部硬化治疗在有效率上明显优于单纯局部硬化治疗，且并发症少。

关键词: 普萘洛尔, 局部硬化治疗, 临床疗效, 并发症

Objective:

To study the clinical efficacy and occurrence of complication of oral propranolol combined with local sclerotherapy for the treatment of large hemangioma in children.

Methods:

Totally 237 infants (≤ 5 months old) with large hemangioma in Wuhan Children’s Hospital from January 2013 to April 2016 were selected and divided into two groups. The patients in simple treatment group (86 cases) were given local sclerosis treatment. Procedures were as follows: under the guidance of DSA or B ultrasound, multi-point puncture was performed on the tumor, after withdrawing blood, the sclerotherapy agent was slowly injected into the tumor tissue. The patients in combined treatment group (151 cases) were orally given propranolol combined with local sclerotherapy after 24 h long-term ECG is normal. 237 cases were followed up for 3 months to 1.5 years, and the clinical efficacy and complications in two groups were compared.

Results:

The total effective rate in combined treatment group was 96.7% (146/151) , which was higher than that of simple treatment group (89.5%, 77/86) , with significant difference (χ²=5.045, P<0.05) . The cure rate of combined treatment group was 71.5% (108/151) , which was higher than that of simple treatment group (47.7%, 41/86) , with significant difference (χ²=13.350, P<0.01) . The incidence of complications in combined treatment group was 25.8%, which was lower than that of the simple treatment group (38.4%) , with significant difference (χ²=4.077, P<0.05) .

Conclusion:

Oral propranolol combined with local sclerotherapy is significantly better than the local sclerotherapy, with less comparison.

Key words: Propranolol, Local sclerotherapy, Clinical efficacy, Complications

表1 2组的临床疗效比较　例（%）

组别	例数	治愈	显效	有效	无效	总有效(%)
单纯治疗组	86	41(47.7)	25(29.1)	11(12.8)	9(10.5)	77(89.5)
联合治疗组	151	108(71.5)	28(18.5)	10(6.6)	5(3.3)	146(96.7)
χ²值	?	?	?	?	?	5.045
P值	?	?	?	?	?	0.025

表1 2组的临床疗效比较　例（%）

组别	例数	治愈	显效	有效	无效	总有效(%)
单纯治疗组	86	41(47.7)	25(29.1)	11(12.8)	9(10.5)	77(89.5)
联合治疗组	151	108(71.5)	28(18.5)	10(6.6)	5(3.3)	146(96.7)
χ²值	?	?	?	?	?	5.045
P值	?	?	?	?	?	0.025

图1 典型病例1（女，3月，右前臂血管瘤）治疗前后效果图

图2 典型病例2（男，3月，右背部皮肤及皮下组织血管瘤）治疗前后效果图

图3 治疗后不同时间的效果比较

表2 两组并发症发生情况比较　例（%）

组别	例数	发热	胃肠道反应	局部肿胀	溃疡坏死	组织凹陷	合计
单纯治疗组	86	5(5.8)	7(8.1)	16(18.6)	3(3.5)	2(2.3)	33(38.4)
联合治疗组	151	6(4.0)	9(6.0)	18(11.9)	5(3.3)	1(0.7)	39(25.8)
χ²值	?	?	?	?	?	?	4.077
P值	?	?	?	?	?	?	0.043

表2 两组并发症发生情况比较　例（%）

组别	例数	发热	胃肠道反应	局部肿胀	溃疡坏死	组织凹陷	合计
单纯治疗组	86	5(5.8)	7(8.1)	16(18.6)	3(3.5)	2(2.3)	33(38.4)
联合治疗组	151	6(4.0)	9(6.0)	18(11.9)	5(3.3)	1(0.7)	39(25.8)
χ²值	?	?	?	?	?	?	4.077
P值	?	?	?	?	?	?	0.043

1	Frieden IJ, Haggstrom A, Drolet BA, et a1. Infantile hemangiomas: current knowledge, future directions: proceedings of a research workshop on infantile hemangiomas[J]. Pediatr Dermatol，2005，22(5):383-406.
2	Finn MC, Glowacki J, Mulliken JB, et al. Congenital vascular lesions: clinical application of a new classification[J]. J Pediatr Surg，1983，18(6):894-900.
3	Baharudin A, Samsudin AR, Halim AS,et al.Surgical management of a massive facial hemangioma[J]. Med J Malaysia, 2007,62(3):254-255.
4	Komiyama M, Nakajima H, Kitano S，et al. Endovascular treatment of huge cervicofacial hemangioma complicated by Kasabach-Merritt syndrome[J]. Pediatr Neurosurg，2000，33(1):26-30.
5	中华口腔医学会口腔颌面外科专业委员会脉管性疾病学组.口腔颌面部血管瘤及脉管畸形的诊断和治疗指南（草案）[J].中华口腔医学杂志，2005,40(3):185-186.
6	Léauté-Labrèze C, Dumas de la Roque E, et al. Propranolol for severe hemangiomas of infancy [J]. N Engl J Med, 2008, 358(24):2649-2651.
7	Jadhav VM, Tolat SN. Dramatic response of propranolol in hemangioma: report of two cases[J]. Indian J Dermatol Venereol Leprol, 2010, 76(6):691-694.doi: 10.4103/0378-6323.72472.
8	Holmes WJ, Mishra A, Gorst C, et a1. Propranolol as firstline treatment for rapidly proliferating Infantile Haemangiomas[J]. J Plast Reconstr Aesthet surg, 2011, 64(4):445-451.
9	许熠铭，谢民强，刘贤,等.颈部囊性淋巴管瘤患者术后疗效观察[J].临床耳鼻咽喉头颈外科杂志,2010,24(9):400-402.
10	赵丽君，杜玉杰，刘爽，等.三种镇痛方法在人工流产术中的应用比较[J].中国煤炭工业医学杂志，2006, 19(7):2495-2497.
11	Gelmetti C, Frasin A, Restano L. Innovative therapeutics in pediatric dermatology[J]. Dermatol Clin, 2010, 28(3):619-629. doi: 10.1016/j.det.2010.03.005.
12	Lawley L, Siegfried E. Propranolol treatment for hemangiomas of infancy：risks and recommendations[J]. Pediatr Dermatol，2009，26(5):610-614.
13	Haider KM, Plager DA, Neely DE, et al. Outpatient treatment of periocular infantile hemangiomas with oral propranolol[J]. JAAPOS, 2010,14(3):251-256.
14	Rosbe KW, Suh KY, Meyer AK, et al. Propranolol in the management of infantile hemangiomas[J].Arch Otolaryngol Head Neck Surg,2010, 136(7):658-665. doi: 10.1001/archoto.2010.92.
15	Tan ST, ltinteang T, Leadbitter P. Low-dose propranolol for infantile haemangioma[J]. J Plast Reconstr Aestheti Surg, 2011, 64(3):292-299.
16	Moniotte S, Bataille AC, Clapuyt P，et al. Propranolol for Hemangioma of Infancy durmion of treatment. The 18h International Workshop on Vascular Anomalies，Brussels.2010：21-24.
17	Mousa W, Kues K, Haas E，et al. Successful treatment of a large hemangioma with propranolol[J]. J Dtsch Dermatol Ges，2010，8(3):184-186. doi: 10.1111/j.1610-0387.2009.07266.x.
18	Bonifazi E, Acquafredda A, Milano A，et al. Severe hypoglycemia during successful treatment of diffuse hemangiomatosis with propranolol[J]. Pediatr Dermatol，2010，27(2):195-196. doi: 10.1111/j.1525-1470.2009.01081.x.

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Clinical efficacy and complication study of propranolol combined with local sclerotherapy in treatment of large hemangioma in children≤5 months old

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Clinical efficacy and complication study of propranolol combined with local sclerotherapy in treatment of large hemangioma in children≤5 months old