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3年临床观察

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (1): 48-53.

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3年临床观察

董依云, 周国瑜, 沈玲悦, 徐青, 顾基中

上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科激光中心,上海 200011

收稿日期:2014-06-30 出版日期:2015-02-10 发布日期:2015-03-12
通讯作者: 周国瑜,E-mail: guoyuzhou@hotmail.com E-mail:yiyun_dong@hotmail.com
作者简介:董依云（1988-）,女,硕士研究生,住院医师

Three-year clinical observation of oral corticosteroids combined with long pulsed 1064 nm Nd:YAG laser in the treatment of ulcerated infantile hemangioma

DONG Yi-yun, ZHOU Guo-yu, SHEN Ling-yue, XU Qing, GU Ji-zhong

Lab of Laser Surgery, Department of Oromaxillofacial Head and Neck Oncology, Ninth People′s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2014-06-30 Online:2015-02-10 Published:2015-03-12
About author:Supported by Research Fund of Science and Technology Committee of Shanghai Municipality (12140902202)
Supported by:
上海市科学技术委员会资助项目（12140902202）

摘要/Abstract

摘要： 目的：探讨口服糖皮质激素联合长脉宽1064 nmNd: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。

关键词: 婴幼儿溃疡型血管瘤, 糖皮质激素, 长脉冲1064nm Nd:YAG激光

Abstract: 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 4 weeks, 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 was 1.89±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.

Key words: Ulcerated infantile hemangioma, Corticosteroids, Long pulsed 1064 nm Nd:YAG laser

中图分类号:

R739.8

董依云, 周国瑜, 沈玲悦, 徐青, 顾基中. 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3年临床观察[J]. 中国口腔颌面外科杂志, 2015, 13(1): 48-53.

DONG Yi-yun, ZHOU Guo-yu, SHEN Ling-yue, XU Qing, GU Ji-zhong. Three-year clinical observation of oral corticosteroids combined with long pulsed 1064 nm Nd:YAG laser in the treatment of ulcerated infantile hemangioma[J]. China J Oral Maxillofac Surg, 2015, 13(1): 48-53.

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