婴儿声门下血管瘤治疗初探

Treatment of subglottic hemangioma in infant

目的初步探讨婴儿声门下血管瘤的不同治疗方法及疗效。方法回顾性分析我院自2008～2011年收治的声门下血管瘤患儿13例,7例气管切开术后分次行平阳霉素瘤体内注射,4例口服普萘洛尔治疗,1例口服泼尼松片治疗,1例单纯行气管切开姑息治疗。结果 7例平阳霉素注射治疗,血管瘤完全消退,6例成功拔管,平均疗程7.5个月;4例口服普萘洛尔,3例血管瘤完全消退,1例大部分消退,平均疗程4.8个月;1例口服泼尼松片后8个月声门下肿块大部分消退,伴发库欣综合征;1例单纯气管切开患儿,于3年后血管瘤完全消退,拔除气管套管。结论平阳霉素瘤体内注射疗效是肯定的,但绝大多数患儿需行气管切开,且每次注药均需住院全麻下进行,疗程长。普萘洛尔可短时间内使瘤体缩小、改善呼吸道梗阻症状,避免了手术创伤性操作,且副作用小,可作为一线药物使用。

OBJECTIVE To discuss the different methods of management of subglottic hemangioma in infant.METHODS The clinical data of 13 infants with subglottic hemangioma from 2008 to 2011 were studied.Seven cases were treated with intratumoral injection of Pingyangmycin after tracheotomy.Oral Propranolol was applied in four cases and oral Prednisone in one case.One case only underwent tracheotomy,but had no other treatment.RESULTS In seven cases with intratumoral injection of Pingyangmycin,the tumors disappeared completely and six cases were extubated successfully.The average course was 7.5 months.With oral propranolol treatment,the subglottic hemangioma completely subsided in three cases,and subsided near completely in one case.Average treatment time was 4.8 months.With oral Prednisone,the tumors mostly disappeared after 8 months,but complicated Cushing＇s syndrome.In one case was just with tracheotomy,extubated 3 years later,for naturally complete regression of hemangioma.CONCLUSION Intratumoral injection of Pingyangmycin is thought to be an effective therapy for subglottic hemangioma.But this treatment is applied after tracheotomy and needed general anesthesia every time.Oral propranolol reduces the size of hemangioma more quickly than other methods.It avoids the trauma of surgical operation and the side effects,and can be used as first-line therapeutic method.