单用0.5%噻吗洛尔乳膏与联合得宝松局部注射治疗较厚的浅表型婴幼儿血管瘤的疗效比较

Comparison of Simply Topical Timolol 0.5% Cream and Combined with Intralesional Diprospan Injection for the Treatment of Thick Superficial Infantile Hemangiomas

目的比较单用0．5％噻吗洛尔乳膏与联合局部得宝松注射，治疗较厚的浅表型婴幼儿血管瘤（IH）的临床疗效及安全性。方法自2015年1月至2015年11月，对43例具有一定厚度（2～6mm）的增生期浅表型IH患者进行自身对照研究。病灶一半单纯外用0．5％噻吗洛尔乳膏治疗。而另一半联合局部得宝松注射治疗。乳膏一天涂4次，涂5个月：得宝松注射治疗4周一次。当病灶厚度小于2mm或连续3次注射病灶未见任何反应时停止注射治疗。5个月后．针对治疗前后病灶厚度、颜色及面积进行评分．比较两种方法的有效率及不良反应发生率。结果38例患儿（共39个病灶）完成治疗。两组有效率无统计学差异。联合治疗组的厚度和颜色消退评分，及起效时间均显著优于单纯外用乳膏组，而面积消退方面两者无统计学差异。联合治疗组中2例病灶（5．13％）治疗后出现破溃。2例病灶（5．13％）注射后1个月出现局部萎缩凹陷。1例病灶（2．56％）在两个治疗组中均出现脱皮。结论相比单用乳膏治疗。局部外用0．5％噻吗洛尔乳膏联合得宝松注射治疗较厚的增生期浅表型IH，可缩短起效时间，提高疗效，尤其在厚度及颜色消退方面效果更佳。

Objective To compare the efficacy and safety of simply topical timolol 0.5% cream and timolol combined with intralesional Diprospan in the treatment of thick superficial infantile hemangiomas （IH）. Methods From January to November 2015, 43 patients with thick superficial IH （2-6 mm） were recruited for a self-control study. Half lesion was treated with topical timolol 0.5% cream simply, while the other was treated with topical timolol 0.5% cream combined with Diprospan injection. Cream was applied four times daily for five months, and the injection of Diprospan was given every 4 weeks. The injection time depended on tumor thickness and the effect, when the depth of lesion was less than 2 mm or no further improvement was observed after three treatment procedures, injection treatment should be stopped. Finally, according to the thickness, the color and area score, the effective rate and the incidence rate of adverse reaction were compared between the two groups. Results Thirty-eight patients with thirty-night lesions finished the research. The efficacy rates of topical timolol group and combined treatment group were 92.3% and 97.4%, no significant difference was observed. The combined treatment group exhibited better effect than timolol cream group, especially in the involution of thickness, color and onset time, while not in the involution of area. The side effects included ulceration （5.13%） and soft tissue atrophy （5.13%） were observed in combined treatment group and peeling （2.56%） in both group. Conclusion Compared with simply topical cream, intralesional Diprospan combined with topical timolol 0.5% cream has a better effect for treating superficial IH with a certain protruding degree in the aspects of thickness, color and onset time.