Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA; Zablocki VA Medical Center, Milwaukee, WI, USA.
Am J Otolaryngol. 2022 May-Jun;43(3):103409. doi: 10.1016/j.amjoto.2022.103409. Epub 2022 Feb 19.
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease leading to recurrent epistaxis, telangiectasias, and/or visceral arteriovenous malformations. Multiple treatment methods, including both pharmacologic and surgical, are described to be effective in managing symptomatic HHT. Few report the duration of symptom improvement for each of these treatment methods. This study aims to analyze the duration of effectiveness of coblation treatment for recurrent epistaxis in those with HHT.
Retrospective single-center chart review was completed for patients diagnosed with HHT who underwent coblation treatment by the same otolaryngologist from December 2009 to November 2021. Demographic information was collected along with whether local Bevacizumab was used during each treatment. Months between treatment coblation sessions was used as a surrogate for duration of treatment effectiveness. Descriptive statistics were used for analysis alongside quantitative statistical analysis.
Over the course of 12 years, 57 patients (24 female, 42.11%) with HHT underwent a total number of 150 coblation treatments. The average age at initial coblation was 59 years (29-88) with an average follow-up time of 5 years (1-12 years). Of the 150 coblations, 30 treatments (20%) included bevacizumab injections into the nasal cavity. The average duration of treatment effectiveness across all 150 treatment sessions was 24.5 months (1-87 months). Of the 26 patients (46%) that underwent multiple coblation treatments, the overall average duration of coblation effectiveness was 16.4 months (1-72 mos). When Bevacizumab was utilized, the average duration of effectiveness was 18.3 months (3-62 mos), while the average duration of effectiveness for treatments without Bevacizumab was 15.7 months (1-87 mos, p > 0.251). Further, there was no correlation between duration of treatment effectiveness and age, sex, and race; yet,there was a significant negative correlation between the use of tobacco and duration of coblation effectiveness (p = 0.0202).
Coblation is an effective treatment option for the management of epistaxis in patients with HHT with duration of benefit lasting approximately 2 years. The use of Bevacizumab did not add to the duration of treatment benefit. Further, the duration of benefit was negatively impacted by smoking history.
遗传性出血性毛细血管扩张症（HHT）是一种常染色体显性疾病，可导致反复鼻出血、毛细血管扩张和/或内脏动静脉畸形。已经有多种治疗方法，包括药物治疗和手术治疗，被描述为对有症状的 HHT 有效。很少有报告这些治疗方法中每一种的症状改善持续时间。本研究旨在分析对于 HHT 患者，铥光纤激光消融治疗复发性鼻出血的有效性持续时间。
对 2009 年 12 月至 2021 年 11 月间由同一位耳鼻喉科医生进行铥光纤激光消融治疗的 HHT 患者进行回顾性单中心图表审查。收集了人口统计学信息，以及每次治疗时是否使用局部贝伐单抗。治疗铥光纤激光消融术之间的间隔月数被用作治疗有效性持续时间的替代指标。使用描述性统计分析和定量统计分析进行分析。
在 12 年的时间里，57 名 HHT 患者（24 名女性，42.11%）共接受了 150 次铥光纤激光消融治疗。首次铥光纤激光消融的平均年龄为 59 岁（29-88 岁），平均随访时间为 5 年（1-12 年）。在 150 次铥光纤激光消融中，30 次治疗（20%）包括将贝伐单抗注射到鼻腔中。所有 150 次治疗的平均有效性持续时间为 24.5 个月（1-87 个月）。在接受多次铥光纤激光消融治疗的 26 名患者（46%）中，铥光纤激光消融术的总体平均有效性持续时间为 16.4 个月（1-72 个月）。当使用贝伐单抗时，平均有效性持续时间为 18.3 个月（3-62 个月），而未使用贝伐单抗的治疗的平均有效性持续时间为 15.7 个月（1-87 个月，p>0.251）。此外，治疗有效性持续时间与年龄、性别和种族之间没有相关性；然而，吸烟史与铥光纤激光消融术的有效性持续时间存在显著负相关（p=0.0202）。
铥光纤激光消融术是治疗 HHT 患者鼻出血的有效治疗选择，其获益持续时间约为 2 年。贝伐单抗的使用并未增加治疗获益的持续时间。此外，吸烟史会对获益持续时间产生负面影响。
