普萘洛尔联合马来酸噻吗洛尔治疗严重婴幼儿腮腺区混合型血管瘤的临床观察

Clinical observation of oral propranolol combined with topical timolol maleate in the treatment of severe infantile mixed hemangioma in the parotid region

目的评价口服普萘洛尔联合马来酸噻吗洛尔外用治疗严重婴幼儿腮腺区混合型血管瘤的临床疗效与安全性。方法自2012年10月至2017年10月,对30例患儿给予口服普萘洛尔联合外用马来酸噻吗洛尔治疗。普萘洛尔口服给药按1.0～1.5 mg/kg,0.5%马来酸噻吗洛尔滴眼液局部外涂瘤体表面,联合给药6～8个月或病变完全消退。依据给药前后血管瘤颜色、大小的变化,结合Achauer 4级评分法进行疗效评定,通过治疗期间出现的不良反应情况进行安全性评估。结果 30例患儿平均治疗时间5.3个月。随访3～12个月,疗效评定:Ⅳ级(优)25例;Ⅲ级(好)5例;Ⅱ级(中)0例;Ⅰ级(差)0例。30例均未发生严重的全身或局部不良反应。结论口服普萘洛尔联合马来酸噻吗洛尔外用治疗严重婴幼儿腮腺区混合型血管瘤有望成为治疗严重腮腺区混合型血管瘤的首选方法。

Objective To evaluate the clinical efficacy and safety of oral propranolol combined with topical timolol maleate in the management of severe infantile mixed hemangioma in the parotid region. Methods From October 2012 to October 2017, 30 infants with severe parotid mixed hemangiomas were treated with a combination of oral propranolol and topical timolol maleate. Propranolol was administrated at a dose of 1.0 to 1.5 mg/kg body weight and 0.5% topically timolol maleate was locally coated on the surface of the tumor. The therapy duration was planned for 6 to 8 months or until the hemangioma completely regressed. Combined with the Achauer grade 4 scoring method, the therapeutic efficacy and safety were assessed according to changes in color, size of tumor, and adverse effects throughout the course of treatment. Results The mean therapy duration was 5.3 months. Thirty infants were followed up from 3 to 12 months. The clinical efficacy showed that 25 cases were grade Ⅳ(excellent), 5 cases were grade Ⅲ(good), and no cases were grade Ⅱ(medium) or Ⅰ(poor).No severe systemic or local adverse reactions occurred. Conclusion Oral propranolol combined with topical timolol maleate might be used as the first-line treatment selection in the treatment of infantile parotid mixed hemangioma.