摘要
目的 ：探讨口服糖皮质激素联合长脉宽1064 nm Nd：YAG激光治疗婴幼儿颌面部溃疡型血管瘤的有效性和安全性。方法：选取临床上诊断为颌面部溃疡型血管瘤的婴幼儿患者35例,对病灶清创处理愈合后,采用口服糖皮质激素（泼尼松,4~5 mg/kg·d）联合长脉宽1064 nm Nd：YAG激光（能量140~220 J/cm2,脉宽40~50 ms,3 mm直径光斑）治疗,治疗间隔时间4周,疗程2-4次。治疗后随访观察溃疡愈合情况、病灶生长情况、瘤体消退和软化速度、疼痛缓解时间,以及预后等。结果：35例患者均完成治疗并取得良好疗效。治疗结束时,有效率为85.71%（30/35）;3年随访结束时,有效率为94.28%（33/35）。平均治疗时间3.2±1.6个月。早期清创换药后,溃疡的平均完全再上皮化时间为1.89±0.45周。所有患者在治疗1~2个月后显效,血管瘤病灶停止生长或开始消退,未发生出血、感染及溃疡加重等并发症。其中,20例（57.14%）色素沉着,4例色素脱失（11.43%）,色素改变4~5个月后逐渐自然恢复。15例（42.85%）患者病灶愈合后出现瘢痕,与就诊时病灶表面溃疡情况、血管瘤部位和激光治疗后护理有关。所有患者3年随访中,瘤体逐步软化消退,13例（37.14%）患者病灶完全消退。9例患者需配合二期手术,以达到满意美观疗效。结论：口服糖皮质激素联合长脉宽1064 nm Nd：YAG激光对婴幼儿颌面部溃疡型血管瘤的治疗安全、快速、有效。对婴幼儿溃疡型血管瘤的早期干预十分重要。
PURPOSE： To investigate the efficiency and safety of oral corticosteroids combined with long pulsed 1064 nm Nd：YAG laser in the treatment of ulcerated infantile hemangioma. METHODS： Oral corticosteroids（prednisone, 4-5 mg/kg·d） combined with long pulsed 1064 nm Nd：YAG laser（140-220 J/cm2, 40-50 ms, Gentle YAG, 3 mm spot; Candela, USA）were used for 35 pediatric patients with ulcerated hemangioma, whose lesions healed after debridement. The interval was 4weeks, 2-4 times as a course. After each treatment session, the ulcer healing, lesion improvement, the speed of regression, the time of pain relief, and final outcomes where observed and evaluated. RESULTS： Thirty-five patients of ulcerated infantile hemangioma completed the treatment and achieved good results. The efficiency rate was 85.71%（30/35） after last treatment,while 94.28%（33/35） at 3-year follow up. The average course was 3.2±1.6 months. The average re-epithelialization time was1.89±0.45 weeks after early debridement. All lesions stopped growing or started to regress after 1-2 months treatment. There were no bleeding, infection and other complications. Twenty cases（57.14%） developed hyperpigmentation and 4 cases（11.43%） had depigmentation, which recovered to normal gradually 4 to 5 months after the final treatment. Fifteen patients（42.85%） developed scar, which was related to the lesions at first visit and postoperative nursing. Thirteen cases（37.14%）achieved complete regression at 3-year follow-up. Nine patients required other cosmetic operation to reach satisfied appearance. CONCLUSIONS： Oral corticosteroids combined with long pulsed 1064 nm Nd：YAG laser is safe, fast, effective in the treatment of ulcerated infantile hemangioma. Early intervention is important for ulcerated infantile hemangioma.
出处
《中国口腔颌面外科杂志》
CAS
2015年第1期48-53,共6页
China Journal of Oral and Maxillofacial Surgery
基金
上海市科学技术委员会资助项目(12140902202)~~
作者简介
董依云（1988-），女，硕士研究生，住院医师，E—mail：yiyun_dong@hotmail．com
【通信作者】周国瑜，E-mail：guoyuzhou@hotmail．com
