【摘要】：[目的]評(píng)價(jià)糖皮質(zhì)激素瘤內(nèi)注射治療眼部毛細(xì)血管瘤的臨床效果。 [方法]研究對(duì)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(xì)血管瘤患兒140例,其中130例單獨(dú)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(xué)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(duì)注射藥物種類、方式及劑量等資料進(jìn)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(qiáng)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(qiáng)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(xué)比例尺測(cè)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(hào)分為血流少、中等、豐富三種類型,制定療效判定標(biāo)準(zhǔn),將療效定為治愈、顯效、有效和無效四種,評(píng)價(jià)治療前后毛細(xì)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(jìn)行卡方檢驗(yàn),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(jì)學(xué)差異,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。分析各患兒治療后并發(fā)癥的發(fā)生率；對(duì)出院患兒進(jìn)行隨訪,以獲得其目前身高、體重?cái)?shù)據(jù),分為男女兩組,分別計(jì)算和各年齡段的百分位數(shù)標(biāo)準(zhǔn)值的差值,采用SSPS17.0統(tǒng)計(jì)軟件進(jìn)行軼和檢驗(yàn)以判斷和正常兒童的生長發(fā)育指標(biāo)的差異,以P0.05為差異有統(tǒng)計(jì)學(xué)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(xì)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(yàn)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(qiáng)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(qiáng)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(jìn)行療效分析,χ2=8.193,p0.05,各種治療方式間差別無統(tǒng)計(jì)學(xué)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(fù)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(biāo)準(zhǔn)值的對(duì)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(xì)血管瘤安全、有效、副作用少,且為可逆性,對(duì)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(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R739.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉潛;李靜;周德凱;李曉慶;唐開勇;金先慶;;糖皮質(zhì)激素瘤內(nèi)注射治療嬰幼兒血管瘤機(jī)理的研究[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2007年13期

2 李華雨;許乙凱;林炳權(quán);余田;;腦部毛細(xì)血管瘤MRI表現(xiàn)[J];南方醫(yī)科大學(xué)學(xué)報(bào);2009年05期

3 林天生;陳為民;;~(90)Sr-~(90)Y敷貼治療2862例嬰幼兒皮膚毛細(xì)血管瘤臨床分析[J];福建醫(yī)藥雜志;2010年03期

4 賀曉偉,張文瑛,徐迪;沙培林注射治療小兒特殊部位海綿狀血管瘤[J];海峽藥學(xué);2000年04期

5 向前;許雪亮;劉雙珍;王成業(yè);;氟尿嘧啶聯(lián)合醋酸曲安奈德治療眼瞼毛細(xì)血管瘤的臨床觀察[J];中南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年06期

6 卜戰(zhàn)云;;局部注射曲安萘德治療眼部毛細(xì)血管瘤[J];醫(yī)藥論壇雜志;2007年06期

7 楊麗華;王斌;李超芹;陳運(yùn)洪;;α-2b干擾素成功治療嬰兒巨大血管瘤5例報(bào)告[J];臨床兒科雜志;2011年06期

8 伍尚敏;魯開化;;血管瘤藥物治療的現(xiàn)狀[J];中國美容醫(yī)學(xué);2007年01期

9 魏海剛;邱雅;陳玉婷;李蜀光;;沙培林瘤內(nèi)注射治療體表血管瘤、脈管畸形的國內(nèi)文獻(xiàn)系統(tǒng)評(píng)價(jià)[J];中國美容醫(yī)學(xué);2010年10期

10 雷培蕓;王勇;王贊堯;;血管瘤瘤內(nèi)注射糖皮質(zhì)激素對(duì)腎上腺皮質(zhì)功能的影響[J];四川醫(yī)學(xué);1989年05期

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