长脉冲1064 nm Nd：YAG激光治疗婴儿血管瘤5年回顾分析

摘要/Abstract

摘要：

目的评价长脉冲1064 nm Nd：YAG激光治疗婴儿血管瘤的临床效果和特点。方法吉林大学第一医院皮肤科门诊接受1064 nm Nd：YAG激光治疗的资料完整的婴儿血管瘤病例共794例（900处血管瘤），回顾性分析患者临床资料，包括患者年龄、性别，血管瘤发生时间、病程、类型、位置、面积、并发症及治疗结果。不同性别间的疗效比较采用两组秩和检验；不同疗效患儿的年龄和血管瘤的面积采用中位数 ± 四分位数间距进行描述，组间比较采用多组秩和检验；不同血管瘤的位置和不同血管瘤分类间的疗效比较均采用多组秩和检验；影响血管瘤疗效的多因素分析方法采用有序多分类logistic回归法。结果 794例患儿经1 ~ 5次激光治疗后，总有效率为87.56%（788/900）。疗效与患儿的性别（Z = -7.18，P > 0.05）和血管瘤的位置（χ2 =2.34，P > 0.05）无关，而主要与患儿的年龄（χ2 = 103.131，P < 0.001）和血管瘤类型（χ2 = 107.709，P < 0.001）相关。年龄越大，疗效越好（OR = 1.21，95% CI 1.14 ～ 1.28，P < 0.001）；同单纯血管瘤比较，混合型血管瘤疗效最差（OR = 0.22，95% CI 0.17 ～ 0.29，P < 0.001），其次为深层血管瘤（OR = 0.30，95% CI 0.10 ～ 0.93，P = 0.037）。不良反应包括术后水疱、萎缩性瘢痕、色素沉着、色素减退、皮肤质地改变，未见增生性瘢痕。结论 1064 nm Nd:YAG激光是治疗各种类型早期婴儿血管瘤的有效手段之一。

Abstract:

Zhong Shuxia, Zhou Junfeng, Tao Yuchun, Yao Lei, Song Yang, Liu Yuanyuan, Yan Dongxue, Li Shanshan Department of Dermatology, First Hospital of Jilin University, Changchun 130021, China （Zhong SX, Zhou JF, Yao L, Song Y, Liu YY, Yan DX, Li SS）; Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun 130012, China （Tao YC） Corresponding author: Li Shanshan, Email: shansalee@163.com 【Abstract】 Objective To evaluate the clinical efficacy and characteristics of long-pulsed 1064-nm Nd:YAG laser in the treatment of infantile hemangioma. Methods Totally, 794 cases of infantile hemangioma （including 900 hemangioma lesions） treated with long-pulsed 1064-nm Nd:YAG laser in the First Hospital of Jilin University were included into this study. Clinical data were collected from these patients, including age, gender, age at onset of hemangioma, disease course, clinical types, lesional location and area, complications and treatment outcome. A retrospective analysis was carried out. The Mann-Whitney test was performed to compare therapeutic effects between male and female patients, and the Kruskal-Wallis H test to compare those among hemangioma at different sites and of different types. The central tendency and variability in patients′ age and lesional area were expressed as median ± quartile range, and compared by the Kruskal-Wallis H test among hemangioma showing different therapeutic response. Factors influencing therapeutic response were analyzed by an ordinal multinomial logistic regression analysis. Results After 1 - 5 sessions of laser therapy, the total response rate was 87.56% （788/900） in the 794 patients with infantile hemangioma. There were significant differences in therapeutic response among patients of different ages （χ2 = 103.131, P < 0.001）, among different types of hemangioma （χ2 = 107.709, P < 0.001）, and among different areas of hemangioma （χ2 = 59.35, P < 0.001）, but not between male and female patients （Z = －7.18, P > 0.05） or among hemangioma at different sites （χ2 = 2.34, P > 0.05）. As the ordinal multinomial logistic regression analysis showed, the older the age, the better the therapeutic response （OR = 1.21, 95% CI: 1.14 - 1.28, P < 0.001）. In addition, the therapeutic response was worse in subcutaneous hemangioma than in superficial hemangioma （OR = 0.30, 95% CI: 0.10 - 0.93, P = 0.037）, and worst in mixed hemangioma （OR = 0.22, 95% CI: 0.17 - 0.29, P < 0.001）. Adverse reactions included blisters, atrophic scars, hyperpigmentation, hypopigmentation and changes in skin texture, but no hyperplastic scars were observed. Conclusion Long-pulsed 1064-nm Nd:YAG laser is highly effective for the treatment of various kinds of infantile hemangioma in early stage with a good safety profile.

钟淑霞周俊峰姚蕾宋洋刘媛媛闫冬雪李珊山. 长脉冲1064 nm Nd：YAG激光治疗婴儿血管瘤5年回顾分析[J]. 中华皮肤科杂志, 2016, 49(1): 36-39.doi:

参考文献 19

［1］	Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck［J］. Int J Clin Exp Med, 2013, 6（10）: 851⁃860.
［2］	Raulin C, Greve B. Retrospective clinical comparison of hemangioma treatment by flashlamp⁃pumped （585 nm） and frequency⁃doubled Nd:YAG （532 nm） lasers［J］. Lasers Surg Med, 2001, 28（1）: 40⁃43.
［3］	Yang MU, Yaroslavsky AN, Farinelli WA, et al. Long⁃pulsed neodymium:yttrium⁃aluminum⁃garnet laser treatment for port⁃wine stains［J］. J Am Acad Dermatol, 2005, 52（3 pt 1）: 480⁃490. DOI: 10.1016/j.jaad.2004.10.876.
［4］	Landthaler M, Haina D, Brunner R, et al. Neodymium⁃YAG laser therapy for vascular lesions［J］. J Am Acad Dermatol, 1986, 14（1）: 107⁃117. DOI: 10.1016/S0190⁃9622（86）70014⁃5.
［5］	Anderson RR. Optics of the skin//Lim HW, Soter NA. Clinical photomedicine［M］. New York: Marcel Dekker, 1993: 19⁃35.
［6］	Wirth FA, Lowitt MH. Diagnosis and treatment of cutaneous vascular lesions［J］. Am Fam Physician, 1998, 57（4）: 765⁃773.
［7］	Achauer BM, Chang CJ, Vander Kam VM. Management of hemangioma of infancy: review of 245 patients［J］. Plast Reconstr Surg, 1997, 99（5）: 1301⁃1308.
［8］	Zhong SX, Liu YY, Yao L, et al. Clinical analysis of port⁃wine stain in 130 Chinese patients treated by long⁃pulsed 1064⁃nm Nd: YAG laser［J］. J Cosmet Laser Ther, 2014, 16（6）: 279⁃283. DOI: 10.3109/14764172.2014.946052.
［9］	钟淑霞, 李珊山, 姚蕾, 等. 长脉冲可调脉宽1064 nm Nd:YAG激光在血管性皮肤病治疗中的临床应用［J］. 吉林大学学报（医学版）, 2011, 37（1）: 147⁃149.
	Zhong SX, Li SS, Yao L, et al. Clinical application of long pulse tunable pulse width 1 064 nm Nd:YAG laser in treatment of vascular cutaneous disorders ［J］. J Jilin Univ Med Edit, 2011, 37（1）: 147⁃149.
［10］	姚蕾, 钟淑霞, 李珊山, 等. 长脉冲可调脉宽Nd:YAG激光治疗毛细血管瘤124例［J］. 中华皮肤科杂志, 2009, 42（2）: 88⁃90. DOI: 10.3760/cma.j.issn.0412⁃4030.2009.02.007.
	Yao L, Zhong SX, Li SS, et al. Therapeutic efficacy of long⁃pulsed tunable Nd:YAG laser on capillary hemangioma［J］. Chin J Dermatol, 2009, 42（2）: 88⁃90. DOI: 10.3760/cma.j.issn.0412⁃4030.2009.02.007.
［11］	周国瑜, 沈玲悦, 田克斌, 等. 长脉冲可调脉宽Gentle YAG 1064 nm激光治疗颌面部血管瘤113例效果评估［J］. 上海口腔医学, 2006, 15（3）: 250⁃253. DOI: 10.3969/j.issn.1006⁃7248.2006. 03.002.
	Zhou GY, Shen LY, Tian KB, et al. Treatment of 113 oral and maxillofacial hemangiomas with long pulsed turnable 1064nm Gentle YAG laser［J］. Shanghai J Stomatol, 2006, 15（3）: 250⁃253. DOI: 10.3969/j.issn.1006⁃7248.2006.03.002.
［12］	Hunzeker CM, Geronemus RG. Treatment of superficial infantile hemangiomas of the eyelid using the 595⁃nm pulsed dye laser［J］. Dermatol Surg, 2010, 36（5）: 590⁃597. DOI: 10.1111/j.1524⁃4725.2010.01511.x.
［13］	Tay YK, Tan SK. Treatment of infantile hemangiomas with the 595⁃nm pulsed dye laser using different pulse widths in an Asian population［J］. Lasers Surg Med, 2012, 44（2）: 93⁃96. DOI: 10.1002/lsm.21159.
［14］	Ashinoff R, Geronemus RG. Failure of the flashlamp⁃pumped pulsed dye laser to prevent progression to deep hemangioma［J］. Pediatr Dermatol, 1993, 10（1）: 77⁃80. DOI: 10.1111/j.1525⁃1470.1993.tb00021.x.
［15］	Poetke M, Philipp C, Berlien HP. Flashlamp⁃pumped pulsed dye laser for hemangiomas in infancy: treatment of superficial vs mixed hemangiomas［J］. Arch Dermatol, 2000, 136（5）: 628⁃632. DOI: 10.1001/archderm.136.5.628.
［16］	Zide BM, Levine SM. Hemangioma update: pearls from 30 years of treatment［J］. Ann Plast Surg, 2012, 69（1）: 99⁃103. DOI: 10.1097/SAP.0b013e3182212881.
［17］	郭艳萍, 姜海燕, 马艳秋, 等. 400例儿童皮肤血管异常疗效分析［J］. 中华皮肤科杂志, 2010, 43（10）: 691⁃693. DOI: 10.3760/cma.j.issn.0412⁃4030.2010.10.006.
	Guo YP, Jiang HY, Ma YQ, et al. Analysis of therapeutic efficacy and etiology of hemangioma in 400 children with cutaneous vascular anomalies［J］. Chin J Dermatol, 2010, 43（10）: 691⁃693. DOI: 10.3760/cma.j.issn.0412⁃4030.2010.10.006.
［18］	李敏, 张守民, 李彦, 等. 595 nm脉冲染料激光治疗鲜红斑痣1560例临床研究［J］. 中华皮肤科杂志, 2012, 45（3）: 201⁃202. DOI: 10.3760/cma.j.issn.0412⁃4030.2012.03.016.
	Li M, Zhang SM, Li Y, et al. Flashlamp⁃pumped pulsed dye laser （595 nm） for the treatment of port⁃wine stains: a clinical review of 1560 patients［J］. Chin J Dermatol, 2012,45（3）:201⁃202. DOI: 10. 3760/cma.j.issn.0412⁃4030.2012.03.016.
［19］	Groot D, Rao J, Johnston P, et al. Algorithm for using a long⁃pulsed Nd:YAG laser in the treatment of deep cutaneous vascular lesions［J］. Dermatol Surg, 2003, 29（1）: 35⁃42. DOI: 10.1046/j.1524⁃4725. 2003.29016.x.