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目的 :总结婴幼儿血管瘤患儿口服普萘洛尔停药后的进一步治疗经验,探讨其后期临床干预治疗与病变分型的关系。方法:回顾分析2010年1月—2014年5月接受口服普萘洛尔停药后序贯治疗的137例婴幼儿血管瘤患儿的临床资料。其中男41例,女96例;年龄14~25个月,中位年龄16个月。口服普萘洛尔停药后疗效评价Ⅰ级1例,Ⅱ级62例,Ⅲ级74例,Ⅳ级0例。丘疹型31例,毛细血管扩张型11例,肥厚型74例,复合型9例,深部型12例。位于头皮3例,面部49例,颈部14例,躯干33例,四肢38例。45例合并皮肤松弛,80例合并皮肤深部软组织肥厚。采用激光治疗38例,平阳霉素注射治疗63例,手术切除20例,联合治疗16例。仍按4级评分法对序贯治疗效果进行临床评价,并记录瘢痕增生、皮肤松弛和色素改变情况。采用SPSS18.0软件包进行统计学分析。结果:137例患儿中,后续治疗前各型皮肤松弛和软组织肥厚发生率有显著差异。后续治疗后随访6个月~4 a,疗效评定为Ⅰ级0例,Ⅱ级0例,Ⅲ级15例,Ⅳ级122例。5型患儿序贯治疗前、后远期治疗效果有显著差异(P均<0.01),2例肢体邻近关节患儿术后瘢痕增生,2例注射平阳霉素患儿注射区出现轻度色素改变。结论:肥厚型、深部型和复合型婴幼儿血管瘤口服普萘洛尔治疗后易遗留病变区不同程度的皮肤松弛或软组织肥厚。婴幼儿血管瘤患儿口服普萘洛尔停药后,需根据发病部位、临床分型和残留病变特点确定序贯治疗方案。毛细血管扩张型和丘疹型病变首选激光治疗,必要时联合平阳霉素局部注射;肥厚型病变和复合型病变首选平阳霉素注射治疗,深部型病变和部分增生明显的肥厚型病和复合型病变应考虑手术治疗;术后残余浅表病变,联合应用平阳霉素注射效果较好。
Objective: To summarize the experience of further treatment after oral administration of propranolol in children with infantile hemangiomas and to investigate the relationship between the clinical intervention and the classification of the lesions in infants with hemangiomas. Methods: The clinical data of 137 infantile hemangiomas from January 2010 to May 2014 were retrospectively analyzed. There were 41 males and 96 females, aged from 14 to 25 months, with a median age of 16 months. The efficacy of oral propranolol after stopping the evaluation of grade Ⅰ in 1 case, Ⅱ grade 62 cases, Ⅲ grade 74 cases, Ⅳ grade 0 cases. There were 31 cases of papules, 11 cases of telangiectasia, 74 cases of hypertrophic type, 9 cases of complex type and 12 cases of deep type. In the scalp 3 cases, 49 cases of face, neck 14 cases, 33 cases of trunk, limbs 38 cases. 45 cases with loose skin, 80 cases with deep skin hypertrophy. 38 cases were treated with laser, 63 cases were treated with Pingyangmycin injection, 20 cases were treated by surgery and 16 cases were treated by combination therapy. According to the 4-point score, the clinical effect of sequential treatment was evaluated, and scar hyperplasia, skin relaxation and pigmentation were recorded. SPSS18.0 software package for statistical analysis. Results: There were significant differences in the incidence of skin relaxation and soft tissue hypertrophy among the 137 children before and after treatment. Follow-up 6 months to 4 years after follow-up treatment, 0 cases of grade Ⅰ, 0 cases of grade Ⅱ, 15 cases of grade Ⅲ and 122 cases of grade Ⅳ. There was a significant difference between the two groups in the treatment of type 5 children before and after long-term treatment (P all <0.01). Scar hyperplasia was found in 2 cases of children with adjacent limbs and 2 cases of injection of bleomycin change. Conclusion: The hypertrophic, deep and complex infantile hemangiomas treated with propranolol may have different degrees of skin relaxation or soft tissue hypertrophy in the diseased area. Infants with hemangioma after oral propranolol withdrawal, according to the site of onset, clinical classification and residual disease characteristics to determine sequential treatment. Capillary dilatation and papular lesions preferred laser treatment, when necessary, combined with local injection of pingyangmycin; hypertrophic lesions and compound lesions preferred pingyangmycin injection treatment, deep lesions and some hyperplasia obvious hypertrophic and compound lesions Surgical treatment should be considered; postoperative residual superficial lesions, combined with pingyangmycin injection is better.