婴幼儿血管瘤口服普萘洛尔治疗后的进一步处理

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。

Subsequent therapy for infantile hemangiomas after discontinuation of oral propranolol

PURPOSE To summarize the subsequent therapy experiences for infantile hemangiomas after discontinuation of oral propranolol treatment, and explore the relationships between clinical interventions and types of infantile hemangioma. METHODS In this retrospective study from January 2010 to May 2014, a total of 137 infants with hemangiomas undergoing sequential therapy after oral propranolol treatment. There were 41 males and 96 females. The median age was 16 months, ranging from 14 to 25 months. After oral propranolol treatment, the outcomes were evaluated to be grade Ⅲ in 74 cases, grade Ⅱin 62 cases and grade Ⅰ in 1 case. The types were papula (n=31), telangiectasis (n=11), plump (n=74), deep (n=12) and compound (n=9). The primary sites were 3 cases in scalp, forty-nine in face, thirty-three in trunk, thirty-eight in extremities. Cutis laxa presented in 45 cases, and parenchyma hypertrophy presented in 80 cases. Sequential therapy were performed including laser therapy for 38 cases, intralesional Pingyangmycin injection for 63 cases, and plastic surgery for 16 cases. The efficacy was re-evaluated on a 4-level scale, combined with evaluations of scar, cutis laxa or pigment alteration. SPSS18.0 software package was used for statistical analysis. RESULTS Chi-square test showed significant differences between 5 types in occurrence of cutis laxa and parenchyma hypertrophy (χ2=28.458,68.276, P＜0.01). After a follow-up of 6 months to 4 years, the outcomes were evaluated to be grade IV in 122 cases, grade Ⅲ in 15 cases, without grade Ⅱor gradeⅠ case. There were significant differences in 5 types of infantile hemangiomas before and after sequential therapy( H=53.445，9.941, 120.324, 17.000, 18.899, P＜0.01). Postoperative scar was presented in 2 cases around to joints, and mild pigment alteration was noticed in 2 cases after intralesional Pingyangmycin injection.CONCLUSIONS Cutis laxa and parenchyma hypertrophy may be more likely present in infantile hemangiomas after oral propranolol treatment. Laser therapy is recommended for patients with papula or telangiectasis, when necessary, intralesional Pingyangmycin injection should be combined. Intralesional Pingyangmycin injection should be the first choice for plump or compound type，whereas surgery should be executed in patients with deep type or other plump type complicated by severe hyperplasia, after which combined intralesional Pingyangmycin injection may be required for postoperative superficial residues.