Haykal Nadine, Daniels Kelly, Konanur Anisha, McCoy Jennifer L, Bykowski Michael R, Yilmaz Sabri, Padia Reema
UT Health San Antonio, Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology, 7703 Floyd Curl Drive MC-7777, San Antonio, TX 78229-3900, United States of America.
University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, United States of America.
Am J Otolaryngol. 2023 Nov-Dec;44(6):104005. doi: 10.1016/j.amjoto.2023.104005. Epub 2023 Jul 20.
Puberty has been shown to accelerate growth of vascular malformations, including lymphatic (LM) and venous malformations (VM). This study aims to compare the number of procedures performed before and after puberty in patients with LM and VM to assess whether the onset of puberty results in higher treatment frequency.
A retrospective review of head and neck LM and VM patients who were evaluated between January 2009 and December 2019 was performed. Patient demographics, lesion characteristics, and procedural details were recorded. For the purposes of this study, 11 years or older in females and 12 years or older in males were the established cut-offs for the onset of puberty.
After initial screening of 357 patients, 83 patients were included in the study based on inclusion criteria. There were 34 patients with LM (41 %) and 49 with VM (59 %). The mean age at diagnosis was 6.1 ± 10.9 years (LM: 4.2 ± 7.0, VM: 7.4 ± 12.9, p = 0.489). 68 patients underwent treatments, which included sclerotherapy, surgical excision, and/or laser. For all patients, the average number of lifetime treatments when initiated before puberty was 3.78 ± 2.81 and when initiated after puberty was 2.17 ± 1.37 (p = 0.022). Patients diagnosed pre-puberty were more likely to undergo treatments vs. those diagnosed after puberty (OR 10.00, 95 % CI: 2.61-38.28, p < 0.001).
We found that the number of treatments was fewer in those who started treatment after puberty. This finding suggests that providers may elect to proceed with observation in asymptomatic patients, given that waiting until after the onset of puberty has not shown an increase in the procedural load on patients.
已证实青春期会加速血管畸形的生长，包括淋巴管畸形（LM）和静脉畸形（VM）。本研究旨在比较LM和VM患者青春期前后的手术次数，以评估青春期的开始是否会导致更高的治疗频率。
对2009年1月至2019年12月期间接受评估的头颈部LM和VM患者进行回顾性研究。记录患者的人口统计学资料、病变特征和手术细节。在本研究中，女性11岁及以上、男性12岁及以上被确定为青春期开始的临界值。
在初步筛查的357例患者中，根据纳入标准，83例患者被纳入研究。其中有34例LM患者（41%）和49例VM患者（59%）。诊断时的平均年龄为6.1±10.9岁（LM：4.2±7.0，VM：7.4±12.9，p=0.489）。68例患者接受了治疗，包括硬化治疗、手术切除和/或激光治疗。对于所有患者，青春期前开始治疗时的平均终身治疗次数为3.78±2.81，青春期后开始治疗时为2.17±1.37（p=0.022）。青春期前诊断的患者比青春期后诊断的患者更有可能接受治疗（OR 10.00，95%CI：2.61-38.28，p<0.001）。
我们发现青春期后开始治疗的患者治疗次数较少。这一发现表明，鉴于等到青春期开始后并未显示患者的手术负担增加，医生可能会选择对无症状患者进行观察。
