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目的 :探讨口服糖皮质激素联合长脉宽1064 nm Nd:YAG激光治疗婴幼儿颌面部溃疡型血管瘤的有效性和安全性。方法:选取临床上诊断为颌面部溃疡型血管瘤的婴幼儿患者35例,对病灶清创处理愈合后,采用口服糖皮质激素(泼尼松,4~5 mg/kg·d)联合长脉宽1064 nm Nd:YAG激光(能量140~220 J/cm2,脉宽40~50 ms,3 mm直径光斑)治疗,治疗间隔时间4周,疗程2-4次。治疗后随访观察溃疡愈合情况、病灶生长情况、瘤体消退和软化速度、疼痛缓解时间,以及预后等。结果:35例患者均完成治疗并取得良好疗效。治疗结束时,有效率为85.71%(30/35);3年随访结束时,有效率为94.28%(33/35)。平均治疗时间3.2±1.6个月。早期清创换药后,溃疡的平均完全再上皮化时间为1.89±0.45周。所有患者在治疗1~2个月后显效,血管瘤病灶停止生长或开始消退,未发生出血、感染及溃疡加重等并发症。其中,20例(57.14%)色素沉着,4例色素脱失(11.43%),色素改变4~5个月后逐渐自然恢复。15例(42.85%)患者病灶愈合后出现瘢痕,与就诊时病灶表面溃疡情况、血管瘤部位和激光治疗后护理有关。所有患者3年随访中,瘤体逐步软化消退,13例(37.14%)患者病灶完全消退。9例患者需配合二期手术,以达到满意美观疗效。结论:口服糖皮质激素联合长脉宽1064 nm Nd:YAG激光对婴幼儿颌面部溃疡型血管瘤的治疗安全、快速、有效。对婴幼儿溃疡型血管瘤的早期干预十分重要。
Objective: To investigate the efficacy and safety of oral glucocorticoid combined with long pulse width 1064 nm Nd: YAG laser in the treatment of maxillofacial ulcerated hemangiomas in infants. Methods: Totally 35 infants and children with clinically diagnosed maxillofacial hemangiomas were treated with dexamethasone (prednisone, 4-5 mg / kg · d) combined with long Pulse width 1064 nm Nd: YAG laser (energy 140 ~ 220 J / cm2, pulse width 40 ~ 50 ms, 3 mm diameter spot) treatment, treatment interval of 4 weeks, course of treatment 2-4 times. Follow-up after treatment observed ulcer healing, lesion growth, tumor regression and softening speed, pain relief time, and prognosis. Results: 35 patients completed the treatment and achieved good results. At the end of treatment, the effective rate was 85.71% (30/35). At the end of the 3-year follow-up, the response rate was 94.28% (33/35). The average treatment time was 3.2 ± 1.6 months. After initial debridement dressing, the average complete re-epithelialization time of ulcer was 1.89 ± 0.45 weeks. All patients were treated 1 to 2 months after markedly effective, hemangioma lesions stop growing or beginning to subside, no bleeding, infection and ulcers and other complications. Among them, 20 cases (57.14%) pigmentation, 4 cases of pigmentation loss (11.43%), pigment changes 4 to 5 months after the gradual natural recovery. Fifteen patients (42.85%) had scars after healed, which was related to the ulcer on the surface of the lesion, the site of hemangioma and the care after laser treatment. All patients were followed up for 3 years, the gradual softening of the tumor subsided, 13 cases (37.14%) patients completely subsided. Nine patients need to cooperate with the second phase surgery in order to achieve the satisfactory aesthetic effect. Conclusion: Oral glucocorticoid combined with long-pulse width 1064 nm Nd: YAG laser is safe, rapid and effective for the treatment of maxillofacial ulcerated hemangiomas in infants. Early intervention of infantile ulcerated hemangiomas is very important.