Fuchsmann Carine, Quintal Marie-Claude, Giguere Chantal, Ayari-Khalfallah Sonia, Guibaud Laurent, Powell Julie, McCone Catherine, Froehlich Patrick
Service d'Otorhinolaryngologie Pédiatrique, L'Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69600 Bron, France.
Arch Otolaryngol Head Neck Surg. 2011 May;137(5):471-8. doi: 10.1001/archoto.2011.55.
To report the efficacy of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas.
Multi-institutional retrospective study.
Two tertiary care referral pediatric centers.
Thirty-nine children with head and neck infantile hemangiomas were treated.
Review of clinical records.
Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of β-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping.
Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation.
报告普萘洛尔作为儿童头颈部血管瘤一线治疗药物的疗效，并提出一种优化的血管瘤治疗方案。
多机构回顾性研究。
两家三级医疗转诊儿科中心。
39名头颈部婴儿血管瘤患儿接受了治疗。
临床记录回顾。
60%的患者仅接受普萘洛尔治疗，39例患者中有33例因早期干预在平均4.1个月龄（年龄范围1 - 11个月）开始使用普萘洛尔。普萘洛尔治疗使39个部位中的37个在2天至2周内血管瘤颜色变浅、体积缩小。一个声门下血管瘤和一个鼻尖血管瘤无反应或仅部分反应；在这些患者中，普萘洛尔治疗延迟且在其他治疗失败后进行。成功治疗消退后，出现6例复发；再次使用普萘洛尔后仍有效。延长治疗可避免复发。26个血管瘤位于以往除非出现并发症否则不会开始使用皮质类固醇治疗的部位（鼻子、嘴唇和腮腺区），使用普萘洛尔治疗后迅速得到控制。普萘洛尔治疗的平均持续时间为8.5个月。未发生因并发症而停用β受体阻滞剂的情况，但5例患者因睡眠问题用醋丁洛尔替代了普萘洛尔。
普萘洛尔是治疗头颈部婴儿血管瘤的有效药物，尤其是在快速生长阶段早期开始使用时，是眼眶和喉部血管瘤的一线治疗药物。普萘洛尔的疗效和耐受性使我们对一些以前会选择观察而非进行皮质类固醇治疗的患者使用了普萘洛尔治疗。如果在理论上血管瘤消退后（12个月龄）延长治疗时间，可避免复发。关于最佳剂量和停药年龄仍存在疑问。
