不同方案治疗小儿血管瘤的效果观察

Therapeutic Effect of Different Regimens on Infantile Hemangiomas

目的研究单纯局部药物注射、单纯手术切除、手术联合药物治疗、激光联合药物治疗等不同方案治疗小儿血管瘤的临床效果。方法选取我院2015年3月-2017年3月收治的200例小儿血管瘤患儿为研究对象,在参考患儿家长意愿基础上,将纳入患儿按就诊顺序分为单纯手术组(n=34)、单纯药物组(n=49)、手术联合药物组(n=51)、激光联合药物组(n=66)。单纯手术组采用单纯手术治疗,单纯药物组给予单纯局部药物注射治疗,手术联合药物组先行局部药物注射再行手术治疗,激光联合药物组先行局部药物注射再行CO_2激光治疗。检测单纯药物组、手术联合药物组、激光联合药物组间血管内皮细胞,评估4组临床疗效,对所有患儿进行为期6个月随访,统计并发症发生率与复发率。结果激光联合药物组治疗30 d后血清血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、增殖细胞核抗原(PCNA)显著低于单纯药物组与手术联合药物组(P<0.05)。手术联合药物组治疗总有效率为94.1%,显著高于单纯手术组的79.4%(P<0.05)。激光联合药物组治疗总有效率为90.9%,显著高于单纯药物组的77.6%(P<0.05)。结论对小儿血管瘤先行局部药物注射,再行手术切除或CO_2激光治疗,可有效控制瘤体,改善治疗效果。

Objective To study the clinical efficacy of simple local drug injection,simple surgical resection,surgery combined with drug therapy,laser combined with drug therapy in the treatment of infantile hemangiomas.Methods Two hundred children with infantile hemangiomas who were admitted to the hospital between March 2015 and March 2017 were selected as the subjects. Based on the intentions of parents of these children,the children were divided into the simple operation group（ n = 34）,simple drug group（ n = 49）,operation with drug group（ n = 51） and laser with drug group（ n = 66）. The simple operation group was treated surgically only. The simple drug group was treated with local drug injection alone. The operation with drug group was treated with local drug injection and surgery. The laser with drug group was treated with local drug injection and then CO_2 laser.Vascular endothelial cells in the simple drug group,operation with drug group and laser with drug group were detected. The clinical curative effect in the four groups was evaluated. All the children were followed up for 6 months,and the incidence of complications and recurrence rate were statistically analyzed. Results The serum levels of vascular endothelial growth factor（ VEGF）,basic fibroblast growth factor（ b FGF） and proliferating cell nuclear antigen（ PCNA） in the laser with drug group after 30 d of treatment were significantly lower than those in the simple drug group and operation with drug group（ P 0. 05）. The total response rate of the operation with drug group was significantly higher than that of the simple operation group（ 94.1% vs 79.4%）（ P0.05）,and the total response rate of laser with drug group was significantly higher than that of the simple drug group（ 90.9% vs 77.6%）（ P0.05）.Conclusion Local drug injection followed by surgery or CO_2 laser treatment can effectively control tumors and improve the therapeutic effects in children with infantile hemangiomas.