Jalil Shazia, Akhtar Jamshed, Ahmed Soofia
Department of Paediatric Surgical Unit B, National Institute of Child Health, Karachi.
J Coll Physicians Surg Pak. 2006 Oct;16(10):662-5. doi: 10.2006/JCPSP.662665.
To determine the effectiveness of systemic and intra-lesional corticosteroids, in the management of infantile cutaneous hemangiomas and to compare the results with untreated lesions.
Randomized controlled trial.
Surgical Unit B of National Institute of Child Health, Karachi, from January 2001 to January 2003.
A total of 75 cases with cutaneous hemangiomas were included in the study. Three groups of 25 patients each were made by allocating first patient to control group, every second patient to oral steroid group and every third patient to intra-lesional steroid group. In control group, patients were managed conservatively with repeated hospital visits in order to note down changes occurring in the lesion. In oral steroid group, tablet prednisolone was given at a dose of 2mg/kg/day on alternate days. The dose was gradually tapered over a period of 8 weeks. In intra-lesional steroid group, injection triamcinolone was given at a dose of 1 to 5 mg/kg, with a maximum dose of 30mg. Six injections of triamcinolone in monthly intervals were given. Outcome measures noted were the change in size before and after treatment, duration of proliferative phase, change in morphology and complications.
In the control group,76% lesions showed little or no change, 5.8% had less than 50% reduction and 20% lesions showed actual increase in size. In oral steroid group, 32% lesions showed greater than 50% reduction in size, 44% lesions had less than 50% reduction and 24% lesions had little or no change. In intra-lesional steroid group, 44% lesions showed greater than 50% reduction in size, 32% lesions showed less than 50% reduction and 24% lesions had little or no change. Morphology change in terms of color change, surface bosselation and soft consistency was found in 88% lesions of oral steroid group, 92% in intra-lesional steroid group and 16% in observation group. Complication rate was 16% in observation group, 20% in oral steroid group and 24% in intra-lesional steroid group.
Hemangiomas when left untreated behave in an unpredictable manner. Low dose steroids whether given orally or intra-lesionally, showed remarkable reduction in size with minimal side effects.
确定全身性和瘤内注射皮质类固醇在治疗婴儿皮肤血管瘤中的有效性，并将结果与未治疗的病变进行比较。
随机对照试验。
2001年1月至2003年1月，卡拉奇国家儿童健康研究所外科B组。
本研究共纳入75例皮肤血管瘤患者。将患者分为三组，每组25例，第1例患者分配至对照组，第2例患者分配至口服类固醇组，第3例患者分配至瘤内注射类固醇组。对照组患者采用保守治疗，定期复诊以记录病变变化。口服类固醇组患者隔天服用泼尼松龙片，剂量为2mg/kg/天。剂量在8周内逐渐递减。瘤内注射类固醇组患者注射曲安奈德，剂量为1至5mg/kg，最大剂量为30mg。每月注射一次曲安奈德，共注射6次。观察的结果指标包括治疗前后大小的变化、增殖期持续时间、形态变化和并发症。
对照组中，76%的病变几乎没有变化，5.8%的病变缩小不到50%，20%的病变实际增大。口服类固醇组中，32%的病变大小缩小超过50%，44%的病变缩小不到50%，24%的病变几乎没有变化。瘤内注射类固醇组中，44%的病变大小缩小超过50%，32%的病变缩小不到50%，24%的病变几乎没有变化。口服类固醇组88%的病变、瘤内注射类固醇组92%的病变以及观察组16%的病变在颜色变化、表面隆起和质地变软方面出现形态变化。观察组并发症发生率为16%，口服类固醇组为20%，瘤内注射类固醇组为24%。
血管瘤若不治疗，其发展难以预测。低剂量类固醇无论是口服还是瘤内注射，均能显著缩小血管瘤大小，且副作用最小。
