Chantharatanapiboon Wiratt
Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
J Med Assoc Thai. 2008 Oct;91 Suppl 3:S90-6.
Hemangiomas, one of the most common childhood neoplasms, exhibit a characteristic history of rapid proliferation and slow spontaneous involution. Most of hemangiomas are often managed conversatively, requiring numerous years for spontaneous involution. However hemangiomas can threaten function in 10% to 20% of cases, less than 1% are truly life threatening. All these serious hemangiomas require treatment to avoid severe sequelae and in some rare cases to save the infant's life.
To evaluate the efficacy, side effects, and influencing factors of intralesional triamcinolone in enhancing regression of various sizes and locations of hemangiomas and to discuss the optimal time and interval of the treatment.
The retrospective study was done on 160 pediatric patients with hemangiomas, treated with intralesional triamcinolone injection at age 1 month to 15 years by the author at Queen Sirikit National Institute of Child Health from March 1995 to March 2008. Data were collected from interviews, examinations, medical records, photographs and telephone conversations. Standard statistical methods were used for comparison. The hemangioma sizes were classified into small (> 0-3 cm), medium (> 3-6 cm) and large (> 6-9 cm). Indications for the treatment were rapidly growing lesions, lesions with visual problems, bleeding, ulceration and cosmetic concern. Intralesional injection of triamcinolone was given in a dose of 1 to 2 mg/kg of body weight (maximum of 60 mg). The interval between the treatments varied from 4 to 12 weeks. Most patients were followed up at monthly interval at least 14 months through clinic visits. Mean follow-up was 3.6 years (range 14 months to 12 years).
One hundred and sixty patients, 111 girls and 49 boys were treated with this technique. The mean age at first injection was 16.1 months, with a range from 2 months to 9 years. The number of intralesional triamcinolone injection varied from single injection to twelve injections with a mean of 5.7 injections. The overall response rate was 90% (excellent at 70% and good at 20%). Maximum response was observed in children below the age of 1 year (excellent at 77.8% and good at 15.7%) and parotid hemangiomas (excellent at 93.1% and good at 6.9%). The difference between hemangiomas sizes and treatments interval result was not of statistical significance.
Intralesional administration of triamcinolone was devoid of systemic side effects and an effective initial modality for rapidly growing hemangiomas.
血管瘤是儿童最常见的肿瘤之一，具有快速增殖和缓慢自然消退的特征性病程。大多数血管瘤通常采用保守治疗，需要数年时间才能自然消退。然而，10%至20%的病例中血管瘤会影响功能，不到1%的病例会真正危及生命。所有这些严重的血管瘤都需要治疗以避免严重后遗症，在某些罕见情况下还需要挽救婴儿生命。
评估瘤内注射曲安奈德促进不同大小和部位血管瘤消退的疗效、副作用及影响因素，并探讨最佳治疗时间和间隔。
对1995年3月至2008年3月在诗丽吉王后国家儿童健康研究所由作者治疗的160例儿童血管瘤患者进行回顾性研究。这些患者年龄在1个月至15岁之间，接受瘤内注射曲安奈德治疗。数据通过访谈、检查、病历、照片和电话交谈收集。采用标准统计方法进行比较。血管瘤大小分为小（>0 - 3厘米）、中（>3 - 6厘米）和大（>6 - 9厘米）。治疗指征为快速生长的病变、有视觉问题的病变、出血、溃疡以及美容方面的考虑。瘤内注射曲安奈德的剂量为1至2毫克/千克体重（最大60毫克）。治疗间隔为4至12周。大多数患者通过门诊每月随访至少14个月。平均随访时间为3.6年（范围14个月至12年）。
160例患者中，111例为女孩，49例为男孩接受了该技术治疗。首次注射时的平均年龄为16.1个月，范围从2个月至9岁。瘤内注射曲安奈德的次数从单次注射到12次不等，平均为5.7次。总体有效率为90%（优70%，良20%）。1岁以下儿童（优77.8%，良15.7%）和腮腺血管瘤（优93.1%，良6.9%）的反应最佳。血管瘤大小和治疗间隔结果之间的差异无统计学意义。
瘤内注射曲安奈德无全身副作用，是快速生长型血管瘤有效的初始治疗方式。
