多西环素与平阳霉素治疗儿童大囊型淋巴管畸形的比较研究

Comparative study on doxycycline and pingyangmycin in treatment of large cystic lymphatic malformation in children

目的比较注射用盐酸多西环素与注射用盐酸平阳霉素治疗儿童大囊型淋巴管畸形的临床疗效。方法选取2012年1月-2017年6月天津市儿童医院治疗的60例大囊型淋巴管畸形的患儿作为研究对象,将患儿根据治疗药物的不同分为对照组和治疗组,每组各30例。对照组在DSA透视下经皮注射注射用盐酸平阳霉素8 mg、碘海醇注射液4 mL与生理盐水4 mL组成的混合液,完成后摄片,平阳霉素用量为从病变中吸出体积的1/3~1/2,但总量不超过8 mg。治疗组在DSA透视下经皮注射注射用盐酸多西环素0.1 g、碘海醇注射液2.5 mL与生理盐水2.5mL组成的混合液,完成后摄片,多西环素用量为从病变中吸出体积的1/3~1/2,但总量不超过250 mg。所有患儿均于治疗后4周随访,4周后若患儿未达治愈标准可重复进行,3~5次为1个疗程,术后随访18个月。观察两组患者的临床疗效,比较两组瘤体体积变化情况和不良反应情况。结果治疗后,对照组和治疗组总有效率分别为80.0%、96.7%,两组比较差异有统计学意义(P<0.05)。治疗后,两组病变瘤体体积均显著减少,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组病变瘤体体积显著小于对照组,两组比较差异具有统计学意义(P<0.05)。治疗期间,对照组和治疗组的不良反应发生率分别为33.3%、10.00%,两组比较差异具有统计学意义(P<0.05)。结论多西环素治疗儿童大囊型淋巴管畸形的疗效优于平阳霉素,可以显著减少病变瘤体体积,安全性高,具有一定的临床推广应用价值。

Objective To compare the clinical effects of Doxycycline Hyclate for injection and Bleomycin A5 Hydrochloride for injection in treatment of large cystic lymphatic malformation in children. Methods Children(60 cases) with large cystic lymphatic malformation in Tianjin Children’s Hospital from January 2012 to June 2017 were divided into control and treatment groups according to the different treatment drugs, and each group had 30 cases. Children in the control group were percutaneous injection administered with Bleomycin A5 Hydrochloride for injection 8 mg, and the mixture of 4 mL Iohexol Injection with 4 mL normal saline. The dosage of pingyangmycin was 1/3 to 1/2 of the volume extracted from the lesion, but the total dosage was not more than 8 mg. Children in the treatment group were percutaneous injection administered with Doxycycline Hyclate for injection 0.1 g, and the mixture of 4 mL Iohexol Injection with 2.5 mL normal saline. The dosage of doxycycline was 1/3 to 1/2 of the volume extracted from the lesion, but the total dosage was not more than 250 mg. Children were followed up for 4 weeks after treatment, and if the children did not reach the cure standard, they could be repeated. A course of treatment was 3 to 5 times, and the follow-up period was 18 months. After treatment, the clinical efficacy was evaluated, and the changes of tumor volume and the incidence of adverse reactions in two groups were compared. Results After treatment, the clinical efficacy in the control and treatment group were 80.0% and 96.7%, respectively, and there were differences between two groups(P < 0.05). After treatment, the tumor volumes in two groups were significantly reduced, and there were differences in the same group(P < 0.05). After treatment, the tumor volume in the treatment group was significantly lower than those in the control group, and there were differences between two groups(P < 0.05). During the treatment period, the incidence of adverse reactions in the control group and the treatment group were 33.3% and 10.00%, respectively, and there were differences between two groups(P < 0.05). Conclusion Doxycycline Hyclate for injection is superior to Bleomycin A5 Hydrochloride for injection in treatment of large cystic lymphatic malformation in children, which can significantly reduce the volume of the lesion and has high safety, which has a certain clinical application value.