Li Min, Liu Juan, Valeska Maya, Luo Dan, Zhou Bingrong
Department of Dermatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China.
Department of Dermatology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
Chin Med Sci J. 2017 Jun 10;32(2):100-6. doi: 10.24920/J1001-9294.2017.013.
Objective We investigated the efficacy and safety of 1064 nm Nd: YAG laser, intense pulsed light (IPL), and lauromacrogol injection in the treatment of hemangioma, in order to evaluate the value of color Doppler ultrasound guidance in choosing the optimal treatment modality. Methods Infantile patients who were clinical diagnosed as hemangiomas were randomly divided into group A, who had color Doppler ultrasound examinations before the treatment, and group B who had the treatment without ultrasound evaluation. Patients in the group A were assigned into subgroups according to the depth of lesion by sonography: group A-1 for those who had a lesion depth <1.2 mm, and took intense pulsed light therapy; group A-2 for those who had a lesion depth ≥1.2mm and < 3 mm, and took long pulse 1064 nm Nd:YAG laser therapy; group A-3 for those who had a lesion depth ≥3mm and <5 mm, and were treated by IPL combined with long pulse 1064 nm Nd:YAG laser treatment; Group A-4 for those who had a lesion depth ≥5 mm, and took lauromacrogol injection therapy. Patients in the group B took long pulse 1064 nm Nd:YAG laser treatment without preoperative ultrasound evaluation. The efficacy and adverse reactions of the treatments between the groups were evaluated and compared statistically.Results Totally 113 patients with 128 skin lesions were enrolled in this study, 85 in the group A (mean age 6.8±7.9 months) and 28 in the group B (mean age 6.9±9.9 months). The mean depth of hemangioma was 3.3±1.1 mm in the group A, ranging from 0.5-7.8 mm, with 0.8±0.4 mm, 2.2±0.4 mm, 4.2±0.6 mm and 6.2±0.7 mm in group A1, A2, A3 and A4, respectively. The cure rates and effective rates in the group A were significantly higher than those in the group B (cure rates: 64.5% vs 56.3%, U=3.378, P=0.045; effective rates: 89.5% vs 78.1%, U=4.163, P=0.041). The adverse effect rates of the group A (vesicle 20.0%, pigmentation 46.9%, scarring 17.7%) were lower than those of the group B (vesicle 21.9%, pigmentation 60.4%, scarring 25.0%). Incidences of pigmentation and scarring were statistically significantly different (U=3.884, P=0.034, and U=4.016, P=0.032 respectively) between the two groups.Conclusion With the guidance of color Doppler ultrasound, the efficacy and safety of long pulse 1064 nmNd:YAG laser, intense pulsed light, and lauromacrogol injection in the treatment of infantile hemangioma have better outcomes compared to laser treatment alone without preoperative ultrasound examination.
目的 我们研究了1064nm Nd:YAG激光、强脉冲光（IPL）及聚桂醇注射治疗血管瘤的疗效和安全性，以评估彩色多普勒超声引导在选择最佳治疗方式中的价值。方法 将临床诊断为血管瘤的婴幼儿患者随机分为A组（治疗前进行彩色多普勒超声检查）和B组（未进行超声评估即接受治疗）。A组患者根据超声检查的病变深度分为亚组：A-1组病变深度<1.2mm，接受强脉冲光治疗；A-2组病变深度≥1.2mm且<3mm，接受长脉冲1064nm Nd:YAG激光治疗；A-3组病变深度≥3mm且<5mm，接受IPL联合长脉冲1064nm Nd:YAG激光治疗；A-4组病变深度≥5mm，接受聚桂醇注射治疗。B组患者未进行术前超声评估，接受长脉冲1064nm Nd:YAG激光治疗。对两组治疗的疗效及不良反应进行评估并统计学比较。结果 本研究共纳入113例患者的128处皮肤病变，A组85例（平均年龄6.8±7.9个月），B组28例（平均年龄6.9±9.9个月）。A组血管瘤平均深度为3.3±1.1mm，范围为0.5 - 7.8mm，A1、A2、A3和A4组分别为0.8±0.4mm、2.2±0.4mm、4.2±0.6mm和6.2±0.7mm。A组的治愈率和有效率显著高于B组（治愈率：64.5% vs 56.3%，U = 3.378，P = 0.045；有效率：89.5% vs 78.1%，U = 4.163，P = 0.041）。A组的不良反应发生率（水疱20.0%，色素沉着46.9%，瘢痕形成17.7%）低于B组（水疱21.9%，色素沉着60.4%，瘢痕形成25.0%）。两组间色素沉着和瘢痕形成的发生率差异有统计学意义（分别为U = 3.884, P = 0.034和U = 4.016, P = 0.032）。结论 在彩色多普勒超声引导下，与术前未进行超声检查单纯激光治疗相比，长脉冲1064nm Nd:YAG激光、强脉冲光及聚桂醇注射治疗婴幼儿血管瘤的疗效和安全性有更好的结果。
