Leung Alexander K C, Lam Joseph M, Leong Kin F, Hon Kam L
Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Pediatr Rev. 2021;17(1):55-69. doi: 10.2174/1573396316666200508100038.
Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life.
To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas.
A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement.
Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
婴儿血管瘤是婴儿期最常见的血管肿瘤，在1岁前高达12%的婴儿会受到影响。
使医生熟悉婴儿血管瘤的自然病程、临床表现、诊断及治疗。
2019年11月在PubMed临床查询中使用关键词“婴儿血管瘤”进行检索。检索策略包括过去20年内发表的荟萃分析、随机对照试验、临床试验、观察性研究及综述。本综述仅纳入英文文献发表的论文。从上述检索中获取的信息用于撰写本文。
大多数婴儿血管瘤出生时并不存在。它们常在出生后的头几周以苍白区域出现，随后出现毛细血管扩张或淡红色斑。然后，在出生后的前3至6个月迅速生长。浅表病变呈鲜红色、突出、有小瘤状或表面光滑，边界清晰。深部病变呈蓝色且为圆顶形。婴儿血管瘤持续生长至9至12个月龄，此时生长速度减缓至与儿童生长同步。退化通常在儿童1岁左右开始。约50%的婴儿血管瘤在儿童5岁时会完全退化；70%在7岁时会消失；95%在10至12岁时会消退。大多数婴儿血管瘤无需治疗。治疗选择包括口服普萘洛尔、外用噻吗洛尔和口服糖皮质激素。积极干预的指征包括对治疗无反应的出血、在可能发生严重并发症的部位即将发生溃疡、影响重要结构、危及生命或功能的并发症以及明显毁容。
治疗应个体化，取决于病变的大小、生长速度、形态、数量和位置、现有或潜在并发症、与治疗相关的益处和不良事件、患者年龄、家长关注程度以及医生对各种治疗选择的熟悉程度。目前，口服普萘洛尔是高危和复杂婴儿血管瘤的首选治疗方法。对于需要治疗的浅表婴儿血管瘤以及口服普萘洛尔有严重不良事件风险的患者的复杂婴儿血管瘤，可考虑外用噻吗洛尔。
