Aesthetic outcome of intralesional injection of lauromacrogol as a single-agent treatment for uncomplicated infantile hemangiomas: A long-term follow-up study

Infantile hemangiomas (IH) are at risk of incomplete regression with remnant permanent sequelae, ranging from passive waiting for spontaneous regression to active systemic administration. The application of traditional therapy involving injection of a sclerosing agent is limited due to the difficulty in achieving cosmetic improvement. This study aimed to explore a new injection method that could not only promote tumor regression but also achieve cosmetic improvement. A total of 122 IH (from 109 children) injected intralesionally with lauromacrogol in the Plastic Surgery Department of Fujian Medical University Union Hospital between 1 January 2012 and 1 June 2019 were enrolled in this study. The mean follow-up time was 2.9 years. Of 122 lesions studied, 111 (91.0%) achieved complete regression, 10 (8.2%) achieved significant regression and one (0.8%) achieved moderate regression. In terms of aesthetic appearance, 70 (57.4%) IH had no sequelae and the A score was 5/5. Twenty-one (17.2%) IH had minimal hyperpigmentation, hypopigmentation or telangiectasia and the A score was 4/5. Thirty-one (25.4%) IH had left mild or relatively obvious sequelae and the A score was 1–3/5. None of the 122 IH involved had rebound growth after terminating the treatment. Hyper- or hypopigmentation gradually faded over time and part of the IH had already returned to normal appearance by the time of long-term follow up. The results indicated that this new type of injection therapy significantly promoted the regression of uncomplicated IH and helped achieve the expected cosmetic appearance.     

聚桂醇局部注射治疗婴儿血管瘤疗效观察

目的:评价聚桂醇局部注射治疗婴儿体表血管瘤的临床疗效。方法:对65例不同部位的婴儿血管瘤注射聚桂醇注射液,通过3～7个月的观察,判断其疗效。结果:65例患儿,其中治愈15例,部分治愈45例,改善5例,有效率92.3%。结论:聚桂醇治疗婴儿血管瘤无需住院,安全、有效、方便,治疗后无明显瘢痕,符合美容要求。     

内镜超声引导下聚桂醇消融治疗胰腺囊性肿瘤长期疗效的前瞻性研究（含视频）

目的在大样本基础上进一步探讨内镜超声引导下聚桂醇消融术（endoscopic ultrasonography-guided lauromacrogol ablation,EUS-LA）治疗胰腺囊性肿瘤（pancreatic cystic neoplasms,PCNs）的安全性和长期疗效。方法前瞻性纳入2015年4月—2019年4月解放军总医院第一医学中心255例疑诊PCNs的患者,其中仅使用聚桂醇作为消融剂行EUS-LA治疗的患者共计57例。以消融术后影像学体积变化为疗效评估标准,并观察记录并发症发生情况。结果纳入的57例行EUS-LA治疗的PCNs患者年龄（52.0±14.6）岁,其中女38例、男19例。33例病变位于胰腺头颈部,24例位于胰腺体尾部。共有50例患者接受影像学随访,EUS-LA治疗后囊肿的中位体积从术前的11 434.1 mm3减小至639.4 mm3 （Z=-5.556,P<0.01）,中位直径从32.0 mm减小至12.0 mm（Z=-6.161,P<0.01）,完全缓解24例（48.0%）,部分缓解14例（28.0%）,稳定12例（24.0%）。12例患者进行第2次消融,总消融69例次,总体并发症发生率为4.3%（3/69）。随访12个月以上的患者34例,其中18例（52.9%）获得完全缓解,9例（26.5%）获得部分缓解, 7例（20.6%）病变稳定。结论EUS-LA治疗PCNs安全有效,且长期疗效稳定。     

EUS-guided lauromacrogol ablation of insulinomas: a novel treatment

Background and aims: EUS-guided ablation with ethanol has been used to treat insulinoma since 2006 as a minimally invasive alternative for those who are unwilling or unsuitable for surgeries. However, pancreatic fistula, pancreatitis and other adverse effects were found after the procedure in these patients. Herein, we aimed to find a novel feasible injection.

Methods: Seven patients with different chief complaints were diagnosed with insulinoma by symptoms, lab results and pathology results from EUS fine needle aspiration. All the patients refused to have surgeries and were treated by EUS-guided ablation with lauromacrogol. The injection volume was calculated by tumor size. All the patients were followed up by at least 1 month to see if there is any adverse effect. Blood glucose (BG), insulin and C-peptide levels were monitored before and after the procedure.

Results: Insulinoma size ranged from 0.76?cm ×0.84?cm to 3.39?cm ×1.84?cm. With a mean injection volume of 1.9?ml (range from 0.9 to 3.9?ml), all the patients showed relief in symptoms after the procedure. During the follow up, their BG, insulin and C-peptide levels went back to normal. None of the patients had any adverse effect.

Conclusions: EUS-guided ablation with lauromacrogol showed good treatment results and received no adverse effect after the procedure. Hence, we consider it as an effective and safe method to treat insulinoma.     

超声引导肝癌裸鼠模型瘤体内注入聚桂醇实验研究

目的 对比研究聚桂醇、无水乙醇及生理盐水经超声介入硬化治疗荷瘤肝癌模型的作用效果,探讨聚桂醇能否成为治疗原发性肝癌的新型硬化剂.方法 取BALB/C裸鼠30只及人肝癌HepG2型细胞系构建裸鼠肝癌模型,将18只造模成功荷瘤裸鼠随机分为聚桂醇组(n=6)、无水乙醇组(n=6)及生理盐水组(n=6),分别向模型瘤体中央部位注入相应药物和生理盐水进行治疗实验,观察原发性肝癌状况;超声测量各组瘤体大小,计算肿瘤生长抑制率,苏木精-伊红染色观察瘤体超声影像学改变,镜下观察肿瘤内部及周围病理学改变.结果 实验鼠造模成功18只,皮下瘤体结节均肉眼可见.聚桂醇组和无水乙醇组肿瘤生长明显受抑制(瘤体缩小,1例完全消失),总有效率100％,肿瘤生长抑制率达77.13％,病理学检查见肿瘤组织大片坏死,细胞核固缩;生理盐水组瘤体体积随时间增加无缓解.结论 聚桂醇可抑制BALB/C裸鼠原发性肝癌模型,达到与无水乙醇相似的近期硬化效果,有望成为治疗肝癌的理想硬化剂.     

聚桂醇在单纯性肾囊肿硬化治疗中的应用价值

目的 评价聚桂醇在单纯性肾囊肿硬化治疗中的应用价值.方法 分析65例患者共68个单纯性肾囊肿,行超声引导下抽尽囊液后注入适量聚桂醇硬化剂,并留置于囊腔内,治疗过程中观察患者的反应,详细记录患者主诉,所有患者术后1、3、6、12个月复查超声.结果 穿刺成功率100％.术后随访12个月,治愈率70.6％ (48/68),有效率100％(68/68).8例患者(12.3％)注入聚桂醇时有轻度不适感,1例患者出现晕厥.结论 聚桂醇在单纯性肾囊肿硬化治疗中相对安全、有效,值得在临床推广应用.     

聚桂醇局部注射对不同年龄和部位小儿血管瘤的疗效分析

目的 探讨聚桂醇注射治疗小儿血管瘤的疗效。方法 回顾性分析2014年6月~2019年6月间,在江门市妇幼保健院小儿外科收治的体表血管瘤患儿90例,给予多点注射聚桂醇治疗,采用Achauer疗效评价方法进行评估,记录瘤体面积变化、取得疗效所需的时间及并发症。结果 聚桂醇第一疗程总体有效率95.56%,第二疗程有效率可达100%,其中头面颈部的体表血管瘤起效最快,年龄越小效果越好。四肢的血管瘤并发症最高,达5.56%;肿胀和疼痛是最常见的并发症。结论 聚桂醇局部注射治疗小儿血管瘤取得良好的临床效果,疗程短且并发症发生率低,可广泛应用于小儿体表血管瘤的治疗。     

超声内镜引导下细针注射术治疗胰岛素瘤的中长期疗效分析

2017年6月—2021年5月在中南大学湘雅二医院消化内科共11例胰岛素瘤患者接受超声内镜引导下细针注射术(endoscopic ultrasound-guided fine needle injection, EUS-FNI)治疗。所有患者EUS-FNI治疗后中位随访45个月(12～60个月), 6例患者仅1次治疗即可获得临床症状缓解, 4例患者2次治疗症状缓解, 仅1例患者需要2次以上治疗。以上结果初步显示EUS-FNI治疗胰岛素瘤可获得较好的中长期疗效。     

超声引导下单纯无水乙醇与无水乙醇联合聚桂醇注射硬化治疗卵巢内膜异位囊肿的效果比较

目的：评价超声引导下单纯无水乙醇与无水乙醇联合聚桂醇注射硬化治疗对卵巢内膜异位囊肿的临床疗效。方法：选取2010年1月―2017年12月间因卵巢内膜异位囊肿接受超声引导下硬化治疗的患者99例,分为无水乙醇联合聚桂醇治疗组(观察组,46例)与单纯无水乙醇治疗组(对照组,53例)。回顾性分析两组患者治疗前后的超声表现,并比较其临床疗效及并发症发生情况。结果：观察组与对照组治愈率比较差异无统计学意义(P>0.05)。观察组不良反应(腹痛、醉酒反应、低热)发生率均显著低于对照组(P<0.05)。结论：超声引导下硬化治疗能够有效治疗卵巢子宫内膜异位囊肿。与单纯无水乙醇注射相比较,无水乙醇联合聚桂醇注射硬化治疗并不能提高治愈率,但是可以减少不良反应的发生率,有一定的临床应用价值。     

Clinical Evaluation of Color Doppler Ultrasound in Selecting the Optimal Treatment Modality for Infantile Hemangioma

Objective We investigated the efficacy and safety of 1064 nm Nd: YAG laser, intense pulsed light (IPL), and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography: group A-1 for those who had a lesion depth <1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth≥1.2mm and < 3 mm, and took long pulse 1064 nm Nd:YAG laser therapy; group A-3 for those who had a lesion depth≥3mm and <5 mm, and were treated by IPL combined with long pulse 1064 nm Nd:YAG laser treatment; Group A-4 for those who had a lesion depth≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd:YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically. Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A (mean age 6.8±7.9 months) and 28 in the group B (mean age 6.9±9.9 months). The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm,4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B (cure rates: 64.5%vs 56.3%,U=3.378, P=0.045; effective rates: 89.5%vs 78.1%,U=4.163,P=0.041). The adverse effect rates of the group A (vesicle 20.0%, pigmentation 46.9%, scarring 17.7%) were lower than those of the group B (vesicle 21.9%, pigmentation 60.4%, scarring 25.0%). Incidences of pigmentation and scarring were statistically significantly different (U=3.884,P=0.034, andU=4.016,P=0.032 respectively) between the two groups. Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd:YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.