聚桂醇注射治疗皮肤血管瘤和静脉畸形临床疗效及安全性的Meta分析

目的 :利用Meta分析系统评价聚桂醇注射治疗皮肤血管瘤和静脉畸形的疗效及安全性。方法 :计算机检索MEDLINE、Cochrane Library、PubMed、中国知网(CNKI)、维普(VIP)期刊全文及万方电子期刊全文数据库,检索所有关于聚桂醇注射治疗血管瘤和静脉畸形的随机对照研究,文献检索日期截止至2019年4月1日。对最终纳入的所有研究进行质量评价,使用RevMan 5.3软件进行Meta分析。结果:共纳入17个随机对照研究,1 399例皮肤血管瘤和静脉畸形患者。结果显示,聚桂醇治疗血管瘤或静脉畸形的有效率和安全性均高于平阳霉素;聚桂醇治疗血管瘤的有效率和安全性与口服普萘洛尔组相比,差异均无统计学意义;聚桂醇联合平阳霉素治疗血管瘤或静脉畸形的有效率和安全性均高于单独使用平阳霉素;聚桂醇联合口服泼尼松治疗血管瘤的有效率高于单独口服泼尼松;聚桂醇联合脉冲染料激光(PDL)治疗血管瘤的有效率高于单独使用PDL,但2者不良反应率相比,差异无统计学意义。结论:聚桂醇注射治疗皮肤血管瘤和静脉畸形均有较好的有效性及安全性,聚桂醇单独用药或联合用药时均有确切的疗效。     

聚桂醇泡沫硬化剂治疗婴幼儿血管瘤79例临床观察

目的评价聚桂醇泡沫硬化剂局部注射治疗婴幼儿血管瘤的临床疗效和安全性。方法收集经多普勒超声或者磁共振确诊的79例婴幼儿血管瘤患者,予局部注射聚桂醇泡沫硬化剂,随访3个月~1年。结果接受1~5次者依次为16例、31例、17例、11例、4例。无效5例,好转12例,显效13例,治愈49例,有效率93.67%。均未发生严重并发症。结论聚桂醇泡沫硬化剂局部注射治疗婴幼儿血管瘤操作简单,安全有效。     

普萘洛尔治疗婴幼儿血管瘤溃疡疗效观察

目的探讨普萘洛尔治疗婴幼儿血管瘤溃疡的疗效。方法传统治疗组为2005年1月-2009年4月治疗婴幼儿血管瘤溃疡43例,以局部治疗为主;2009年5月-2011年6月治疗21例,在传统治疗方法的基础上给予口服普萘洛尔治疗,剂量为1.5～2.0mg/(kg·d),比较两组的疗效。结果两组患儿均被治愈,但普萘洛尔治疗组疗程(21.3±7.3d)明显短于传统治疗组(56.5±18.9d);且普萘洛尔治疗组局部瘢痕发生率(14.29%)明显低于传统治疗组(60.47%),以上差异均有统计学意义(P均<0.05)。结论婴幼儿血管瘤溃疡在传统局部创面治疗的基础上若给予口服普萘洛尔治疗,能加速患儿创面愈合和减少发生并发症。     

口服用药联合局部注射用药治疗婴幼儿血管瘤的效果分析

目的探讨口服用药及局部注射用药联合治疗婴幼儿血管瘤的应用价值。方法选择2013年6月~2015年6月我院收治的婴幼儿血管瘤病例86例,随机分成研究组与对照组(n=43),对照组口服普萘洛尔治疗,研究组在对照组的基础上局部注射平阳霉素与康宁克通-A进行治疗。采用酶联免疫吸附法(ELISA)测定两组患儿治疗前及治疗2个月末血清和尿液中血管内皮生长因子-A(VEGF-A)的含量,比较分析两组临床疗效及不良反应发生情况。结果研究组治疗总有效率为97.7%,明显高于对照组治疗总有效率76.7%(P0.05)。两组治疗前血清及尿液VEGF-A水平比较差异均无统计学意义(P0.05),治疗2个月末,研究组血清及尿液VEGF-A水平均低于对照组(P0.01)。两组不良反应发生率差异无统计学意义(P0.05)。结论口服普萘洛尔及局部注射平阳霉素与康宁克通-A联合治疗婴幼儿血管瘤效果显著,可有效改善患儿临床症状,降低患儿血清和尿液中VEGF-A的表达,不良反应少,值得应用及推广。     

口服与外用普萘洛尔治疗婴幼儿草莓状血管瘤疗效比较

目的:评价口服和外用普萘洛尔治疗婴幼儿血管瘤的有效性和安全性。方法:42例血管瘤患儿随机分为A、B两组(每组21例),A组口服1.5 mg/(kg·d)普萘洛尔,B组局部外用1%普萘洛尔软膏,日3次。治疗结束后随访6个月评价疗效。结果:A组12例效果优(57.1%),B组5例效果优(23.8%),两组比较有显著性差异,(P0.05),两种方法均未出现严重的副作用。结论:口服普萘洛尔的疗效好于局部外用,但对于口服药物不能耐受的病例可选择外用普萘洛尔软膏。     

普萘洛尔治疗婴幼儿血管瘤疗效及复发现象的分析

目的随访和观察29例婴幼儿血管瘤患儿口服普萘洛尔治疗后的疗效及复发情况,以指导临床合理用药。方法采用口服普萘洛尔治疗婴幼儿血管瘤患儿29例,年龄52d～11个月。普萘洛尔2.0mg（/kg·d）,分3次餐后口服,服药4～6个月后停药。结果口服普萘洛尔后平均1周,瘤体颜色开始变淡、萎缩变软。治疗3个月后,大部分瘤体明显萎缩。治疗6个月时,瘤体基本消退,表面遗留毛细血管扩张。停药后1个月,6例患儿出现血管瘤复发,且年龄均〈11个月。继续给予原方案治疗约3个月,瘤体显著萎缩,随访3个月,无复发。结论口服普萘洛尔治疗婴幼儿血管瘤具有良好疗效。患儿血管瘤复发现象可能与停药后血管瘤仍处于增生期有关,停药后毛细血管内皮细胞继续增生,异常血管再次形成,血管瘤复发。     

婴幼儿血管瘤的局部药物治疗进展

目的 婴幼儿血管瘤是婴幼儿最常见的良性软组织肿瘤。普萘洛尔治疗婴幼儿血管瘤的安全性和有效性均优于传统的糖皮质激素,但口服普萘洛尔可导致系统性并发症。局部应用β受体阻滞剂成为婴幼儿血管瘤治疗研究的新热点,如局部外用0.5%噻吗洛尔滴眼液、0.1%噻吗洛尔凝胶、普萘洛尔纳米水溶胶等。另外,局部外用5%咪喹莫特软膏、局部注射药物以及联合不同波长激光等均可作为婴幼儿血管瘤的治疗选择。本文简要综述婴幼儿血管瘤局部药物治疗方法。     

聚桂醇局部注射治疗婴幼儿血管瘤疗效观察

目的:观察泡沫硬化剂聚桂醇治疗婴幼儿血管瘤的效果。方法:56例婴幼儿血管瘤,应用聚桂醇注射液0.4~4.0 mL向瘤体内局部多点均匀注射,每4周治疗1次,由家长和医师根据瘤体颜色、肿胀程度及生长情况共同评估治疗效果,疗效分为治愈、显效、有效和无效。同时记录并发症。结果:平均注射3.5次(1~5次),痊愈40例(71.4%),显效8例(14.3%),有效7例(12.5%),无效1例(1.8%),有效率85.7%,无明显不良反应。结论:聚桂醇局部注射治疗血管瘤是一种安全有效、简便易行的方法。     

普萘洛尔口服治疗婴幼儿血管瘤的效果观察

目的观察普萘洛尔口服治疗婴幼儿血管瘤的临床疗效。方法选取2016年1月～2017年12月100例我院住院部收治婴幼儿血管瘤患儿作为研究对象,按照数字表法随机分为观察组与对照组。对照组采用泼尼松治疗,观察组则采用普萘洛尔治疗。观察两组患儿的临床疗效以及不良反应的发生率差异。结果观察组患儿的临床疗效及不良反应发生率明显优于对照组(P0.05)。结论普萘洛尔在婴幼儿血管瘤临床治疗中具有较高的临床疗效和安全性,值得在临床中推广使用。     

普萘洛尔联合595 nm脉冲染料激光治疗婴幼儿血管瘤疗效观察

目的研究口服普萘洛尔联合595 nm脉冲染料激光治疗婴幼儿血管瘤疗效。方法选取2016年1月-2017年10月就诊于新疆维吾尔自治区人民医院皮肤性病科的婴幼儿血管瘤患儿60例,所有患儿被分为实验组及对照组,每组各30例患者。实验组患儿接受595 nm脉冲染料激光照射联合口服普萘洛尔治疗,对照组患儿仅接受595 nm脉冲染料激光治疗。结果实验组[96. 67%(29/30)]疗效高于对照组[86. 67%(26/30)],实验组患儿的愈合时间及激光治疗次数均少于对照组,差异有统计学意义(P 0. 05)。两组患儿不良反应发生率差异无统计学意义。结论口服普萘洛尔联合595 nm脉冲染料激光治疗对于婴幼儿血管瘤患儿有显著疗效,相对于单纯激光治疗,联合治疗可以有效缩短治疗时间、提高治疗效果,未增加不良反应。     

博来霉素瘤体内注射与外用治疗浅表型婴幼儿血管瘤的疗效比较

目的：比较瘤体内注射与外用博来霉素治疗浅表型婴幼儿血管瘤的疗效。方法： 选取2018年12月至2019年12月我院小儿矫形外科住院浅表型血管瘤患儿,随机分成两组,分别予以博来霉素瘤体内注射治疗与瘤体表面外涂治疗。结果：共收集40例浅表型婴幼儿血管瘤,注射组与外用组各20例。外用组显效12例,有效8例,注射组显效14例,有效6例,两组疗效差异无统计学意义（P>0.05）。注射组治疗后瘤体质地硬,而外用组治疗后瘤体质地软;注射组主要不良反应为瘤体局部坏死或感染（P<0.05）,外用组未见明显不良反应。结论：外用博来霉素治疗浅表型婴幼儿血管瘤疗效确切,治疗后不良反应少。     

普萘洛尔治疗婴儿血管瘤复发因素分析

目的 了解口服普萘洛尔治疗婴儿血管瘤中导致复发的因素.方法 对235例口服普萘洛尔治疗且已经停用普萘洛尔6个月的血管瘤患儿复发因素进行调查,使用单因素和多因素非条件logistic回归模型进行分析.结果 235例患儿停药6个月内复发66例,复发率28.1％(66/235),其中15例属于严重复发,占复发病例的22.7％(15/66).复发的危险因素包括服药剂量为1.5 mg· kg-1·d-1(OR=3.566,95％ CI:1.306～ 9.739),首次服药时年龄＞8周(OR=5.043,95％ CI:1.248 ～ 20.376),服药疗程≤6个月(OR=17.661,95％ CI:4.899 ～ 63.665),停药时年龄＜1岁(OR=6.089,95％ CI:1.835 ～ 20.204).结论 影响普萘洛尔治疗婴儿血管瘤复发的危险因素较多,应针对这些危险因素采取措施,降低复发率.     

Failure of Intralesional Propranolol in Infantile Hemangiomas

The purpose of this study was to evaluate the use of intralesional propranolol injection in the management of small, noncomplicated infantile hemangiomas (IHs) located in areas of cosmetic concern. A prospective study was performed in six female infants with small, non‐complicated IHs in areas of cosmetic concern. The parents had refused oral propranolol or the patients had no response to topical timolol or had relapsed after oral propranolol and the parents refused further systemic treatment. All six patients were treated with 1 mg/mL propranolol solution at a dose of 0.2 mL/cm². The size, color, and growth of the hemangiomas were monitored and recorded every 4 weeks. Treatment response was evaluated using a 5‐point scale: much better (+2), better (+1), same (0), worse (?1), and much worse (?2). Heart rate and blood pressure were measured before and 1 hour after each injection. Adverse effects after medication were evaluated and managed accordingly. All hemangiomas stopped growing during therapy, but no significant changes in size or color were observed, even after repeated injections, and all patients were evaluated as 0 (same). One patient whose hemangioma stopped growing during treatment presented rebound growth after therapy cessation. No changes in heart rate or blood pressure were observed after intralesional propranolol injection. Adverse effects observed were pain and redness after injection. Intralesional propranolol seems safe but is not effective for the treatment of IH.     

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

There is no uniform pretreatment cardiac evaluation for infants treated with oral propranolol, which is now the drug of choice for hemangiomas of infancy requiring systemic medical intervention. The aim of this study was to report and evaluate the findings of pretreatment cardiac evaluation. Data were reviewed for patients evaluated by a single hemangioma specialist and a single pediatric cardiologist prior to initiation of propranolol for infantile hemangioma. Cardiac evaluation included a complete echocardiogram. From July 2009 through January 2013, 239 consecutive patients 12 months of age or younger (median 2.7 months) were screened. No patients had cardiac contraindications to propranolol. However, 50 patients (21%) had an abnormal echocardiogram: 39 atrial septal defects (5 associated with right heart enlargement), 6 ventricular septal defects, 2 patent ductus arteriosus, 1 aortic coarctation, 1 pulmonary valve stenosis, and 1 aberrant subclavian artery. Overall, 69 patients had an audible heart murmur, 44 of which were not associated with pathologic findings on echocardiogram. All patients with a ventricular septal defect and 16 of 39 with an atrial septal defect had a murmur. Two of seven patients with PHACE syndrome had cardiac anomalies. None of the findings precluded the use of propranolol. Assisted reproductive technologies were used in 18% of pregnancies, including in vitro fertilization in 12%. Cardiac contraindications to propranolol treatment are uncommon in patients with infantile hemangioma. However, anatomic abnormalities were more common than reported in the general population. Further study is necessary to determine whether there is a pathogenic relationship between cardiac defects and nonsyndromic infantile hemangioma.     

外用噻吗洛尔和激光治疗婴幼儿血管瘤疗效比较

目的：比较外用噻吗洛尔和激光治疗婴幼儿浅表型血管瘤的疗效。方法： 回顾性分析91例外用0.5%噻吗洛尔与85例PDL和Nd:YAG双波长激光治疗的婴幼儿浅表型血管瘤的疗效,瘤体连续2个月无继续改善停止治疗。结果： 噻吗洛尔组总有效率84.6%,激光组总有效率88.2%,差异无统计学意义（P＞0.05）。激光组平均治疗时间及瘤体消退76%～100%的时间分别为2.95±1.30和2.27±1.21个月,短于噻吗洛尔组的7.57±3.28和6.57±2.22个月,两组比较差异均有统计学意义（均P＜0.01）。结论： 两种方法治疗婴幼儿浅表型血管瘤疗效相近,激光治疗较外用噻吗洛尔控制快、疗程短。     

Prolonged growth of infantile hemangioma after pulsed dye laser and oral propranolol treatment

Infantile hemangiomas are the most common tumor of childhood and undergo rapid growth during early infancy followed by gradual involution. After involution, residual lesions sometimes remain. Oral propranolol usually induces earlier involution and redness reduction of infantile hemangiomas. However, the optimal treatment duration is unknown and infantile hemangiomas sometimes recur after cessation of treatment. We report three Japanese patients with recurrent infantile hemangiomas on their cheek. These patients were a 1‐month‐old female baby with a superficial infantile hemangioma, a 3‐month‐old female baby with a mixed infantile hemangioma and a 4‐month‐old male baby with a mixed infantile hemangioma. Two of them also received pulsed dye laser treatment. They did not reach complete or nearly complete resolution of infantile hemangiomas at week 25. These patients experienced regrowth of their infantile hemangioma after 20 months of age and took propranolol after the age of 24 months. There were no severe adverse effects. Propranolol may not only be therapeutic but also prophylactic. Patients with infantile hemangiomas who have taken oral propranolol should be followed up at least 6 months after cessation of treatment, especially infantile hemangiomas on the cheek, and those with partial response to propranolol may require close attention in prolonged growth.     

口服普萘洛尔治疗婴儿血管瘤的近期和远期安全性

【摘要】 婴儿血管瘤是婴儿期最常见的肿瘤,其发病率可达4% ~ 5%。血管瘤可分为高、中、低三个风险等级。目前对于高危血管瘤患者采取口服药治疗,系统治疗的一线药物为普萘洛尔（β受体阻滞剂）。应用普萘洛尔治疗血管瘤至今已有10年时间,因其有效率高及安全性好成为系统治疗的首选药物,但其远期不良反应仍需进一步研究评估。     

Propranolol for infantile hemangiomas

Propranolol has been used successfully in a limited number of children with infantile hemangiomas. This multicenter retrospective study describes the efficacy and adverse effects of propranolol in infantile hemangioma. Seventy-one infants with infantile hemangiomas were treated with oral propranolol, 1 mg/kg/12 hours, for at least 12 weeks. A photograph based severity scoring assessment was performed by five observers to evaluate efficacy, utilizing a scoring system of 10 as the original infantile hemangioma before treatment and 0 as completely normal skin. The mean of the five independent measurements was used in the analysis. Propranolol was a rapid and effective treatment for infantile hemangiomas at 4 weeks (p < 0.001), at 8 weeks (p < 0.001 compared to the 4 wks value), at 12 weeks (p < 0.05 compared to the 8 wks value), and thereafter up to 32 weeks (p < 0.01 compared to the 16 wks value). The response of infantile hemangiomas to propranolol was similar regardless of sex, age at onset of treatment, type of involvement (segmental and nonsegmental), facial segments affected, special locations (eyelid, nasal tip, and parotid region), ulceration, and depth of infantile hemangiomas. Very few side effects were reported; mainly agitated sleep in 10 of 71 patients. In the series of patients in this study, oral propranolol 2 mg/kg/day was a well-tolerated and effective treatment for infantile hemangiomas. Prospective studies are needed to establish the exact role of propranolol in the treatment of infantile hemangiomas.     

5%咪喹莫特乳膏联合普萘洛尔治疗婴幼儿血管瘤42例疗效观察

目的 观察5％咪喹莫特乳膏联合普萘洛尔治疗婴儿血管瘤的疗效和安全性.方法 将入选的122例患者随机分成3组,治疗组42例予普萘洛尔2.0 mg/（kg·d）口服,分3次餐后口服,同时每周3次外用5％咪喹莫特乳膏;对照Ⅰ组39例单纯口服普萘洛尔2.0 mg/（kg· d）,分3次餐后口服;对照Ⅱ组41例单纯每周3次外用5％咪喹莫特乳膏.疗程均为6个月.结果 治疗结束后,治疗组有效率为95.24％,对照Ⅰ组有效率为79.49％,对照Ⅱ组有效率为39.02％,治疗组与对照Ⅰ组、对照Ⅱ组对比,差异均有统计学意义（P＜0.05）,不良反应发生率与2组对照组比较差异无统计学意义.结论 普萘洛尔联合5％咪喹莫特乳膏治疗婴儿血管瘤安全有效.