眼部毛细血管瘤瘤内注射糖皮质激素疗效的研究

发布时间：2018-08-12 12:27

【摘要】：[目的]评价糖皮质激素瘤内注射治疗眼部毛细血管瘤的临床效果。 [方法]研究对象为我院自1996年1月至2011年8月约16年间接受糖皮质激素肿瘤内注射治疗的毛细血管瘤患儿140例,其中130例单独使用糖皮质激素,9例为糖皮质激素联合平阳霉素治疗,1例联合氟尿嘧啶(5-FU)注射治疗。分析患儿发病年龄、性别、病变部位、临床表现、影像学检查结果等一般资料,将肿瘤分为眼睑、眶内、睑眶三类；对注射药物种类、方式及剂量等资料进行总结,根据给药方式分组,分为去炎松(曲安奈德)联合地塞米松,得宝松联合地塞米松,甲强龙联合去炎松及地塞米松,去炎松,去炎松联合平阳霉素,地塞米松联合平阳霉素,甲强龙联合地塞米松,得宝松联合去炎松及地塞米松,去炎松联合5-FU9组；通过直尺及影像学比例尺测量治疗前后肿物大小,深度和范围,并根据治疗前后彩色多普勒超声血流图的检查结果,将肿瘤内异常血流信号分为血流少、中等、丰富三种类型,制定疗效判定标准,将疗效定为治愈、显效、有效和无效四种,评价治疗前后毛细血管瘤的大小变化及其治疗的总有效率；将所得数据进行卡方检验,以求得出三种类型肿瘤之间和各种给药方式之间治疗有效率的统计学差异,以P0.05为差异有统计学意义。分析各患儿治疗后并发症的发生率；对出院患儿进行随访,以获得其目前身高、体重数据,分为男女两组,分别计算和各年龄段的百分位数标准值的差值,采用SSPS17.0统计软件进行轶和检验以判断和正常儿童的生长发育指标的差异,以P0.05为差异有统计学意义。 [结果]在所有的瘤内注射糖皮质激素治疗的140例病人中,治愈率为7.1%,显效率为25.7%,有效率为61.4%,总有效率为：94.2%.无效率为：5.8%。 ①所有患儿中眼睑部毛细血管瘤27例,总有效率为：100%；眶内72例,总有效率为：96.2%；睑眶部41例,总有效率为87.6%,按肿瘤发生的部位总有效率为眼睑眶内睑眶；经卡方检验结果：眼睑与眶内相比：z=-1.487p=0.137,眼睑与睑眶相比：z=-3.720p=0.000,眶内与睑眶相比：z=-3.228p=0.001结论：眼睑与眶内疗效要好于睑眶型。 ②在不同治疗方案的疗效中,曲安奈德联合地塞米松52例,总有效率为92.3%。得宝松联合地塞米松治疗50例,总有效率为94%。甲强龙联合去炎松及地塞米松17例；去炎松6例；去炎松联合平阳霉素5例；地塞米松联合平阳霉素4例；甲强龙联合地塞米松3例；得宝松联合去炎松联合地塞米松2例；去炎松联合5-FU1例。在各种治疗方式组合间进行疗效分析,χ2=8.193,p0.05,各种治疗方式间差别无统计学意义。 ③并发症：有5例患儿有毛发增多现象,4例患儿有满月脸现象发生,糖皮质激素副作用的发生率为6.4%。所有的患儿在停药后的随访中均恢复正常。 ④随访66例患者,占患儿总数的47.1%。其中男26人,女40人；随访年龄最大16岁,最小1岁,经与该年龄段身高、体重标准值的对比分析,P0.05,与正常值无明显差异。 [结论]糖皮质激素瘤内注射治疗眼部毛细血管瘤安全、有效、副作用少,且为可逆性,对儿童及青少年的生长发育无明显影响。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.7

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