眼部毛細血管瘤瘤內(nèi)注射糖皮質(zhì)激素療效的研究
發(fā)布時間：2018-08-12 12:27
【摘要】：[目的]評價糖皮質(zhì)激素瘤內(nèi)注射治療眼部毛細血管瘤的臨床效果。 [方法]研究對象為我院自1996年1月至2011年8月約16年間接受糖皮質(zhì)激素腫瘤內(nèi)注射治療的毛細血管瘤患兒140例,其中130例單獨使用糖皮質(zhì)激素,9例為糖皮質(zhì)激素聯(lián)合平陽霉素治療,1例聯(lián)合氟尿嘧啶(5-FU)注射治療。 分析患兒發(fā)病年齡、性別、病變部位、臨床表現(xiàn)、影像學檢查結(jié)果等一般資料,將腫瘤分為眼瞼、眶內(nèi)、瞼眶三類；對注射藥物種類、方式及劑量等資料進行總結(jié),根據(jù)給藥方式分組,分為去炎松(曲安奈德)聯(lián)合地塞米松,得寶松聯(lián)合地塞米松,甲強龍聯(lián)合去炎松及地塞米松,去炎松,去炎松聯(lián)合平陽霉素,地塞米松聯(lián)合平陽霉素,甲強龍聯(lián)合地塞米松,得寶松聯(lián)合去炎松及地塞米松,去炎松聯(lián)合5-FU9組；通過直尺及影像學比例尺測量治療前后腫物大小,深度和范圍,并根據(jù)治療前后彩色多普勒超聲血流圖的檢查結(jié)果,將腫瘤內(nèi)異常血流信號分為血流少、中等、豐富三種類型,制定療效判定標準,將療效定為治愈、顯效、有效和無效四種,評價治療前后毛細血管瘤的大小變化及其治療的總有效率；將所得數(shù)據(jù)進行卡方檢驗,以求得出三種類型腫瘤之間和各種給藥方式之間治療有效率的統(tǒng)計學差異,以P0.05為差異有統(tǒng)計學意義。分析各患兒治療后并發(fā)癥的發(fā)生率；對出院患兒進行隨訪,以獲得其目前身高、體重數(shù)據(jù),分為男女兩組,分別計算和各年齡段的百分位數(shù)標準值的差值,采用SSPS17.0統(tǒng)計軟件進行軼和檢驗以判斷和正常兒童的生長發(fā)育指標的差異,以P0.05為差異有統(tǒng)計學意義。 [結(jié)果]在所有的瘤內(nèi)注射糖皮質(zhì)激素治療的140例病人中,治愈率為7.1%,顯效率為25.7%,有效率為61.4%,總有效率為：94.2%.無效率為：5.8%。 ①所有患兒中眼瞼部毛細血管瘤27例,總有效率為：100%；眶內(nèi)72例,總有效率為：96.2%；瞼眶部41例,總有效率為87.6%,按腫瘤發(fā)生的部位總有效率為眼瞼眶內(nèi)瞼眶；經(jīng)卡方檢驗結(jié)果：眼瞼與眶內(nèi)相比：z=-1.487p=0.137,眼瞼與瞼眶相比：z=-3.720p=0.000,眶內(nèi)與瞼眶相比：z=-3.228p=0.001結(jié)論：眼瞼與眶內(nèi)療效要好于瞼眶型。 ②在不同治療方案的療效中,曲安奈德聯(lián)合地塞米松52例,總有效率為92.3%。得寶松聯(lián)合地塞米松治療50例,總有效率為94%。甲強龍聯(lián)合去炎松及地塞米松17例；去炎松6例；去炎松聯(lián)合平陽霉素5例；地塞米松聯(lián)合平陽霉素4例；甲強龍聯(lián)合地塞米松3例；得寶松聯(lián)合去炎松聯(lián)合地塞米松2例；去炎松聯(lián)合5-FU1例。在各種治療方式組合間進行療效分析,χ2=8.193,p0.05,各種治療方式間差別無統(tǒng)計學意義。 ③并發(fā)癥：有5例患兒有毛發(fā)增多現(xiàn)象,4例患兒有滿月臉現(xiàn)象發(fā)生,糖皮質(zhì)激素副作用的發(fā)生率為6.4%。所有的患兒在停藥后的隨訪中均恢復正常。 ④隨訪66例患者,占患兒總數(shù)的47.1%。其中男26人,女40人；隨訪年齡最大16歲,最小1歲,經(jīng)與該年齡段身高、體重標準值的對比分析,P0.05,與正常值無明顯差異。 [結(jié)論]糖皮質(zhì)激素瘤內(nèi)注射治療眼部毛細血管瘤安全、有效、副作用少,且為可逆性,對兒童及青少年的生長發(fā)育無明顯影響。
[Abstract]:[Objective] to evaluate the clinical effect of glucocorticoid injection in the treatment of ocular capillary hemangioma.
[Methods] 140 cases of capillary hemangioma were treated by intratumoral injection of glucocorticoids from January 1996 to August 2011. Among them, 130 cases were treated with glucocorticoids alone, 9 cases were treated with glucocorticoids combined with pingyangmycin, and 1 case was treated with 5-FU.
The age, sex, location of lesion, clinical manifestations and imaging findings of the patients were analyzed. The tumors were classified into three categories: eyelid, orbital and eyelid. The types, methods and dosages of the injections were summarized. According to the administration methods, the tumors were classified into three groups: deaminasone (triamcinolone acetonide) combined with dexamethasone, diprosone combined with dexamethasone. Methylprednisolone combined with Deyansone and Dexamethasone, Deyansone, Deyansone combined with Pingyangmycin, Dexamethasone combined with Pingyangmycin, Methylprednisolone combined with Dexamethasone and Dexamethasone combined with Dexamethasone, Deyansone combined with Dexamethasone and Dexamethasone combined with 5-FU9 were used to measure the size, depth and scope of the tumor before and after treatment, and according to the treatment. The results of color Doppler ultrasonography before and after treatment divided the abnormal blood flow signals into three types: less blood flow, medium blood flow and rich blood flow. The criteria for judging the curative effect were established. The curative effect was classified into four types: cured, markedly effective, effective and ineffective. Chi-square test, in order to get the three types of tumors and between the various ways of administration of treatment efficiency of statistical differences, with P 0.05 as the statistical significance. The difference of the standard value of percentile in age group was analyzed by SSPS17.0 statistical software to judge the difference of growth and development between normal children and children, and the difference was statistically significant in P 0.05.
[Results] Of all 140 patients treated with intratumoral glucocorticoid injection, the cure rate was 7.1%, the marked effective rate was 25.7%, the effective rate was 61.4%, and the total effective rate was 94.2%. The ineffective rate was 5.8%.
(1) 27 cases of eyelid capillary hemangioma, the total effective rate was 100%; 72 cases of orbital, the total effective rate was 96.2%; 41 cases of eyelid orbital, the total effective rate was 87.6%; according to the location of the tumor, the total effective rate was eyelid orbital; Chi square test results: eyelid and orbital comparison: z = - 1.7P = 0.137, eyelid and eyelid: z = - 3. 720p = 0.000, intraorbital and eyelid orbital: z = - 3.228p = 0.001 Conclusion: Eyelid and intraorbital effect is better than eyelid orbital type.
(2) Among the different therapeutic schemes, 52 cases were treated with triamcinolone acetonide combined with dexamethasone, the total effective rate was 92.3%. 50 cases were treated with diprospane combined with dexamethasone, the total effective rate was 94%. 17 cases were treated with methylprednisolone and dexamethasone, 6 cases were treated with deanisone, 5 cases were treated with deanisone combined with pingyangmycin, 4 cases with dexamethasone combined with pingyangmycin, 4 cases with methylprednisolone There were 3 cases of dexamethasone, 2 cases of diprospane combined with deyansone combined with dexamethasone, and 1 case of deyansone combined with 5-FU.
(3) Complications: There were 5 cases of hair increase, 4 cases of full moon face, the incidence of side effects of glucocorticoids was 6.4%. All the children recovered to normal during follow-up after withdrawal.
(4) Follow-up of 66 patients, accounting for 47.1% of the total number of children, including 26 males and 40 females; follow-up age of the largest 16 years, the smallest 1 years, compared with the age of height, weight standard value, P 0.05, and normal value was no significant difference.
[Conclusion] Intra-tumor injection of glucocorticoid is safe, effective, less side effects and reversible in the treatment of ocular capillary hemangioma.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R739.7
本文編號：2179055
[Abstract]:[Objective] to evaluate the clinical effect of glucocorticoid injection in the treatment of ocular capillary hemangioma.
[Methods] 140 cases of capillary hemangioma were treated by intratumoral injection of glucocorticoids from January 1996 to August 2011. Among them, 130 cases were treated with glucocorticoids alone, 9 cases were treated with glucocorticoids combined with pingyangmycin, and 1 case was treated with 5-FU.
The age, sex, location of lesion, clinical manifestations and imaging findings of the patients were analyzed. The tumors were classified into three categories: eyelid, orbital and eyelid. The types, methods and dosages of the injections were summarized. According to the administration methods, the tumors were classified into three groups: deaminasone (triamcinolone acetonide) combined with dexamethasone, diprosone combined with dexamethasone. Methylprednisolone combined with Deyansone and Dexamethasone, Deyansone, Deyansone combined with Pingyangmycin, Dexamethasone combined with Pingyangmycin, Methylprednisolone combined with Dexamethasone and Dexamethasone combined with Dexamethasone, Deyansone combined with Dexamethasone and Dexamethasone combined with 5-FU9 were used to measure the size, depth and scope of the tumor before and after treatment, and according to the treatment. The results of color Doppler ultrasonography before and after treatment divided the abnormal blood flow signals into three types: less blood flow, medium blood flow and rich blood flow. The criteria for judging the curative effect were established. The curative effect was classified into four types: cured, markedly effective, effective and ineffective. Chi-square test, in order to get the three types of tumors and between the various ways of administration of treatment efficiency of statistical differences, with P 0.05 as the statistical significance. The difference of the standard value of percentile in age group was analyzed by SSPS17.0 statistical software to judge the difference of growth and development between normal children and children, and the difference was statistically significant in P 0.05.
[Results] Of all 140 patients treated with intratumoral glucocorticoid injection, the cure rate was 7.1%, the marked effective rate was 25.7%, the effective rate was 61.4%, and the total effective rate was 94.2%. The ineffective rate was 5.8%.
(1) 27 cases of eyelid capillary hemangioma, the total effective rate was 100%; 72 cases of orbital, the total effective rate was 96.2%; 41 cases of eyelid orbital, the total effective rate was 87.6%; according to the location of the tumor, the total effective rate was eyelid orbital; Chi square test results: eyelid and orbital comparison: z = - 1.7P = 0.137, eyelid and eyelid: z = - 3. 720p = 0.000, intraorbital and eyelid orbital: z = - 3.228p = 0.001 Conclusion: Eyelid and intraorbital effect is better than eyelid orbital type.
(2) Among the different therapeutic schemes, 52 cases were treated with triamcinolone acetonide combined with dexamethasone, the total effective rate was 92.3%. 50 cases were treated with diprospane combined with dexamethasone, the total effective rate was 94%. 17 cases were treated with methylprednisolone and dexamethasone, 6 cases were treated with deanisone, 5 cases were treated with deanisone combined with pingyangmycin, 4 cases with dexamethasone combined with pingyangmycin, 4 cases with methylprednisolone There were 3 cases of dexamethasone, 2 cases of diprospane combined with deyansone combined with dexamethasone, and 1 case of deyansone combined with 5-FU.
(3) Complications: There were 5 cases of hair increase, 4 cases of full moon face, the incidence of side effects of glucocorticoids was 6.4%. All the children recovered to normal during follow-up after withdrawal.
(4) Follow-up of 66 patients, accounting for 47.1% of the total number of children, including 26 males and 40 females; follow-up age of the largest 16 years, the smallest 1 years, compared with the age of height, weight standard value, P 0.05, and normal value was no significant difference.
[Conclusion] Intra-tumor injection of glucocorticoid is safe, effective, less side effects and reversible in the treatment of ocular capillary hemangioma.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R739.7
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