Nishimoto Akana, Ogawa Rei, Akaishi Satoshi
From the Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital; Tokyo; Japan.
Plast Reconstr Surg Glob Open. 2024 Sep 19;12(9):e6192. doi: 10.1097/GOX.0000000000006192. eCollection 2024 Sep.
In Japan, oral propranolol (PPL) and pulsed dye laser are available for infantile hemangioma (IH) treatment without patient cost-sharing. However, no standardized algorithm exists to guide treatment selection that balances efficacy, potential side effects, and aesthetic risks. This study presents a comprehensive approach utilizing a treatment algorithm and aesthetic risk scoring system.
This retrospective study analyzed outcomes from 156 patients with IHs. Oral PPL was used in IH patients with functional issues, whereas the rest underwent an aesthetic risk assessment that categorized them into low-, moderate-, or high-risk groups to guide treatment choices. Final treatment decisions depended on parental preference. The outcomes of algorithm-compliant and noncompliant patients were compared statistically.
The risk score's interrater reliability was 0.973 (95% confidence interval 0.933-0.992), with a mean intrarater reliability of 0.968 ± 0.027 and a mean evaluation time of 14.1 ± 5.0 seconds per case. Among the 156 patients, 88% pursued the algorithm-recommended treatment, whereas 12% opted for different approaches. Algorithm-compliant patients experienced significantly fewer sequelae than did noncompliant patients (5% versus 33%, < 0.001). Compared with noncompliant patients, algorithm-compliant patients tended to require shorter treatment durations (17.9 versus 25.4 mo, = 0.08) and fewer laser sessions (5.8 versus 7.2, = 0.30), with a younger age at resolution (21.3 versus 29.0 mo, = 0.08).
Aesthetic concerns can be crucial for patients with IHs. This study introduces a comprehensive IH management algorithm to reduce the sequelae requiring surgical interventions and improve patients' quality of life.
在日本，口服普萘洛尔（PPL）和脉冲染料激光可用于治疗婴儿血管瘤（IH），患者无需分担费用。然而，目前尚无标准化的算法来指导治疗选择，以平衡疗效、潜在副作用和美学风险。本研究提出了一种利用治疗算法和美学风险评分系统的综合方法。
这项回顾性研究分析了156例IH患者的治疗结果。有功能问题的IH患者使用口服PPL治疗，其余患者接受美学风险评估，将其分为低、中、高风险组，以指导治疗选择。最终的治疗决定取决于家长的偏好。对符合和不符合算法的患者的治疗结果进行统计学比较。
风险评分的评分者间信度为0.973（95%置信区间0.933 - 0.992），评分者内信度均值为0.968±0.027，平均每例评估时间为14.1±5.0秒。在156例患者中，88%接受了算法推荐的治疗，而12%选择了不同的治疗方法。符合算法的患者出现的后遗症明显少于不符合算法的患者（5%对33%，P<0.001）。与不符合算法的患者相比，符合算法的患者治疗持续时间往往更短（17.9个月对25.4个月，P = 0.08），激光治疗次数更少（5.8次对7.2次，P = 0.30），消退时年龄更小（21.3个月对29.0个月，P = 0.08）。
美学问题对IH患者可能至关重要。本研究引入了一种综合的IH管理算法，以减少需要手术干预的后遗症，提高患者的生活质量。
