李雪丽 孙小云 尤加锐 裴军 黄平 黄勇

[摘要]目的：探讨585/1 064nm双波长激光联合普萘洛尔药物治疗婴幼儿浅表性血管瘤的疗效。方法：选取138例浅表性血管瘤患儿为研究对象，分为激光治疗组（n=52）、口服藥物治疗组（n=46）和联合治疗组（n=40）三组。三组患儿每月接受复诊，随访6个月，记录患儿性别、年龄、瘤体部位、瘤体大小、医治时间、医治结果和不良反应。采用Achauer等的评判标准进行疗效评价，同时详细记录治疗过程中每组患儿的不良反应。结果：联合治疗组的有效率97.5%，与激光治疗组的96.2%、口服药物治疗组的95.7%比较，均无显著性差异（P>0.05）;联合治疗组的优良率92.5%，与激光治疗组的65.4%、口服药物治疗组的78.3%相比，联合治疗组的优良率明显升高，且有显著性差异（P<0.05）;联合治疗组达到IV级优的比率62.5%，与激光组治疗组的30.8%、口服药物治疗组的32.6%相比，联合治疗组疗效为优的患儿超过本组治疗人数一半，存在显著性差异，且所需的治疗时间为（4.72±1.03）个月，时间明显短于激光治疗组的（6.65±1.46）个月、口服药物治疗组的（6.83±1.44）个月，且有显著性差异（P<0.05）。三组治疗过程中少数患儿会出现轻微不良反应，如：皮肤水肿、水疱、腹泻、皮疹等，但均未出现危及生命的严重并发症或不良反应。结论：585/1 064nm双波长激光与口服普萘洛尔治疗浅表性婴幼儿血管瘤均能取得满意疗效，但两者联合治疗效果更佳且安全，也在一定程度上缩短了治疗时间。

[关键词]婴幼儿;血管瘤;治疗;激光;普萘洛尔

[中图分类号]R732.2    [文献标志码]A    [文章编号]1008-6455（2021）01-0061-05

Analysis of Therapeutic Effect of Cynergy Dual-wavelength Dye Laser Combined with Propranolol on Superficial Infantile Hemangioma

LI Xue-li1，2，SUN Xiao-yun2，YOU Jia-rui2，Pei Jun2，HUANG Ping2， HUANG Yong1

（1.Department of Burn and Plastic Surgery，Yantai Yuhuangding Hospital， Affiliated Hospital of Qingdao University， Yantai 264000，Shandong，China;2. Department of Plastic and Hand Surgery， Jingmen No. 2 People's Hospital， Jingmen 448000， Hubei，China）

Abstract： Objective  To explore the effect 585/1 064nm double wavelength dye laser combined with propranolol in the treatment of superficial infantile hemangioma. Methods  138 patients with superficial hemangioma were selected and divided into three groups： laser treatment group （n=52）， oral drug treatment group （n=46）， and combined treatment group （n= 40）. The three groups of patients received monthly follow-up visits and were followed up for 6 months. The sex， age， tumor site， tumor size， treatment time， treatment results， and adverse reactions of the children were recorded. Achauer et al. were used to evaluate the efficacy and to record in detail the adverse reactions of each group of children during treatment. Results There was no significant difference between the combination treatment group's effective rate （97.5%）， laser treatment group （96.2%），oral drug treatment group （95.7%）（P>0.05）.The excellent rate （92.5%） of the combination treatment group was compared with the laser treatment group （65.4%） and the oral drug treatment group （78.3%）， the excellent rate in the combination treatment group was significantly increased， there was a difference （P<0.05）.The ratio of the combination treatment group achieving grade IV excellent （62.5%） and the laser treatment group （30.8%） compared with the oral drug treatment group （32.6%）， the children with better efficacy in the combined treatment group exceeded half of the number of treatment in this group， there was a significant difference. And the required treatment time was （4.72±1.03） months ， which was significantly shorter than that in the laser treatment group （6.65±1.46） and the oral drug treatment group （6.83±1.44）， and there was a difference （P<0.05） . During the treatment of the three groups， a small number of children showed slight adverse reactions such as skin edema，blisters，diarrhea，and rash，but none of them had serious life-threatening complications or adverse reactions. Conclusion  Both 585 /1 064nm dual-wavelength laser alone and oral propranolol alone can achieve satisfactory results for superficial infantile hemangiomas， but the combination of the two for superficial infantile hemangiomas is safer and better， and the treatment time is also certain to a lesser extent.

Key words： infant; hemangioma; treatment; laser; propranolol

婴幼儿血管瘤（Infantile hemangioma ，IH）是婴幼儿最常见的良性血源性肿瘤，头面颈部多见，四肢、躯干次之。IH可分为浅表型血管瘤（占约65%），深度型血管瘤（占约20%）及混合型血管瘤（占约15%），一般经历生长期、静止期和消退期三个阶段[1]。IH发病率高达10%左右，男女发病率为1：（3～5）[2]。目前IH可能存在以下几种发病机制：①血管瘤细胞来源与转化失衡;②信号转导通路失调;③肾素-血管紧张素系统异常;④基因发生突变;⑤缺氧、分娩过程中的机械应激及其他外源性因素。大部分IH可自然消退，但自然消退完成后有25%～69%的患儿留有瘢痕、萎缩、色素减退、毛细血管扩张和皮肤松弛等后遗症[3]。剩余约10%IH可能呈继续生长趋势，不仅对患儿外形美观及心理造成严重影响，还可能引起出血、感染、功能障碍等多种并发症。目前……