普萘洛尔与皮质类固醇药物治疗后婴儿血管瘤的手术切除
Surgical resection of infantile hemangiomas following medical treatment with propranolol versus corticosteroids.
作者信息
Polites Stephanie F, Watanabe Miho, Crafton Thomas, Jenkins Todd M, Alvarez-Allende Carlos R, Hammill Adrienne M, Dasgupta Roshni
机构信息
Department of Pediatric Thoracic and General Surgery, Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
Department of Pediatric Thoracic and General Surgery, Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA; Pediatric Surgery, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan, 113-8655.
出版信息
J Pediatr Surg. 2019 Apr;54(4):740-743. doi: 10.1016/j.jpedsurg.2018.08.001. Epub 2018 Sep 5.
PURPOSE
There has been a paradigm shift from corticosteroid to propranolol treatment for infantile hemangiomas (IHs), with surgical resection reserved for complicated or persistent IHs. The purpose of this study was to determine if propranolol treatment was associated with decreased utilization of surgical resection compared to corticosteroids.
METHODS
A single center retrospective chart review of all corticosteroid or propranolol treated IHs between 2005 and 2014 was performed. Demographic and clinical data were collected. Both univariate and multivariate analyses were performed with the primary outcome of requiring surgical intervention.
RESULTS
Of 652 patients with IH, 52 were treated with oral corticosteroids and 195 with propranolol only. Surgical intervention was required in 14 (27%) of steroid patients vs 18 (9%) of propranolol patients (p < .001). On multivariable analysis patients treated with steroids had 3.3 the odds of requiring surgery when compared to propranolol patients (p = .001). Prematurity (<37 weeks) was also associated with increased odds of surgery (OR = 2.8, p = .003).
CONCLUSION
Patients treated with propranolol required significantly fewer surgical interventions than those treated with corticosteroids suggesting a more efficacious treatment paradigm. Prematurity increases the need for surgical intervention regardless of the modality of medical treatment.
LEVEL OF EVIDENCE
Level III, treatment study.
目的
对于婴儿血管瘤（IHs）的治疗，已从皮质类固醇转变为普萘洛尔，手术切除仅用于复杂或持续性IHs。本研究的目的是确定与皮质类固醇相比，普萘洛尔治疗是否与手术切除利用率降低相关。
方法
对2005年至2014年间所有接受皮质类固醇或普萘洛尔治疗的IHs进行单中心回顾性病历审查。收集人口统计学和临床数据。以需要手术干预作为主要结局进行单变量和多变量分析。
结果
在652例IH患者中，52例接受口服皮质类固醇治疗，195例仅接受普萘洛尔治疗。类固醇治疗组14例（27%）需要手术干预，而普萘洛尔治疗组为18例（9%）（p<0.001）。多变量分析显示，与普萘洛尔治疗的患者相比，接受类固醇治疗的患者需要手术的几率高出3.3倍（p=0.001）。早产（<37周）也与手术几率增加相关（OR=2.8，p=0.003）。
结论
与接受皮质类固醇治疗的患者相比，接受普萘洛尔治疗的患者需要的手术干预明显更少，这表明治疗模式更有效。无论采用何种药物治疗方式，早产都会增加手术干预的需求。
证据水平
III级，治疗研究。
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