Yadav Gulab Dhar, Verma Shraddha, Varshney Ashish, Deb Adiveeth
Department of General Surgery, GSVM Medical College, Kanpur, Uttar Pradesh, India.
J Indian Assoc Pediatr Surg. 2022 Jul-Aug;27(4):402-409. doi: 10.4103/jiaps.jiaps_105_21. Epub 2022 Jul 26.
A paradigm shift has occurred regarding the treatment of cutaneous hemangiomas over the last few years, from an open surgical approach to a conservative or minimally invasive approach. There are various treatment modalities described, and response to them is variable and unpredictable. This study was conducted to study the clinical profile of children with uncomplicated cutaneous hemangiomas, their response to oral propranolol, and compare intralesional bleomycin and intralesional triamcinolone among nonresponders to propranolol.
A trial was conducted among 158 children <12 years with cutaneous hemangiomas from January 2019 to October 2020 in Kanpur, Uttar Pradesh. Based on the response to propranolol, partial/nonresponders were later assigned randomly to either receive intralesional bleomycin ( = 30) or intralesional triamcinolone ( = 29). Response to treatment and complications were assessed in two groups. All children were followed up for 6 months.
Of 158 children, complete response to propranolol was found in 99 (62.7% [95% confidence interval (CI): 54.6%-70.1%]) children. Partial and no response was found in 33 (20.9% [95% CI: 15.0%-28.2%]) and 26 (95% CI: 16.5% [11.2%-23.4%]) children, respectively. In the bleomycin group, 66.7%, 23.3%, and 10.0% of patients showed excellent, good, and poor response, respectively, and in the triamcinolone group, 27.6%, 24.1%, and 48.3% showed excellent, good, and poor response, respectively ( = 0.002). However, there was no significant difference between them in terms of complications.
Intralesional bleomycin was found to be a better drug in terms of response compared to triamcinolone. There are no significant differences in complications between them. Further studies are needed to further evaluate the combined efficacy of bleomycin with triamcinolone and other treatment modalities.
在过去几年中，皮肤血管瘤的治疗方式发生了范式转变，从开放手术方法转向保守或微创方法。有多种治疗方式被描述，并且对它们的反应是可变且不可预测的。本研究旨在探讨单纯性皮肤血管瘤患儿的临床特征、他们对口服普萘洛尔的反应，并比较普萘洛尔无反应者中瘤内注射博来霉素和瘤内注射曲安奈德的效果。
2019年1月至2020年10月在北方邦坎普尔对158名12岁以下的皮肤血管瘤患儿进行了一项试验。根据对普萘洛尔的反应，部分/无反应者随后被随机分配接受瘤内注射博来霉素（n = 30）或瘤内注射曲安奈德（n = 29）。评估两组的治疗反应和并发症。所有患儿随访6个月。
158名患儿中，99名（62.7% [95%置信区间（CI）：54.6%-70.1%]）患儿对普萘洛尔完全反应。分别有33名（20.9% [95% CI：15.0%-28.2%]）和26名（95% CI：16.5% [11.2%-23.4%]）患儿部分反应和无反应。在博来霉素组中，分别有66.7%、23.3%和10.0%的患者显示出优、良和差的反应，在曲安奈德组中，分别有27.6%、24.1%和48.3%显示出优、良和差的反应（P = 0.002）。然而，两组在并发症方面没有显著差异。
就反应而言，发现瘤内注射博来霉素比曲安奈德是一种更好的药物。它们在并发症方面没有显著差异。需要进一步研究以进一步评估博来霉素与曲安奈德及其他治疗方式的联合疗效。
