| Background:Infantile hemangioma is the most common benign vascular tumor in infants and young children,with an incidence rate of 4%～10%.The lesions can occur all over the body,most of which are distributed in the head and neck,and 15.8%of the hemangioma distributed in the face invades the nose.Because of the high risk of disfiguration and functional damage to the nasal hemangioma,the American Academy of Pediatrics ranked it as a high-risk management level in 2019.At present,the treatment methods of nasal hemangioma are varied,such as local external application of drugs,systemic treatment,invasive treatment,etc.But no scholars have compared the safety and effectiveness of different treatment methods systematically.And there is no report on the safety of oral propranolol combined with local sclerotherapy(lauromacrogol and triamcinolone acetonide)in the treatment of nasal hemangioma.Objective:Objective to compare the safety and effectiveness of different treatment methods in the treatment of infantile nasal hemangioma through meta-analysis,and to evaluate the safety and effectiveness of oral propranolol combined with local sclerotherapy of lauromacrogol and triamcinolone acetonide,so as to provide reference for clinical treatment.Methods:The first part methods:PubMed,EMBASE database,Cochrane Library,CNKI and Wanfang electronic databases were searched by computer from the establishment of the database to February 2021.The Chinese key words were nose,nasal,hemangioma and treatment.The English key words were subject words and free words.According to the inclusion and exclusion criteria,literatures related to nasal hemangioma treatment were included,and the quality of literatures was evaluated by STROBES list.Finally,33 literatures were included.Data extraction and entry were carried out in detail,and meta-analysis was carried out for the same treatment method with more than 3 literatures.Stata 16.0 software was used for meta-analysis of single group rate,and SPSS 26.0 was used for chi square test to compare the differences between the groups.The second part methods:Retrospective analysis of 46 children with nasal hemangioma who received oral propranolol combined with local sclerotherapy of lauromacrogol and triamcinolone acetonide in Plastic Surgery Department of Shandong Provincial Hospital from 2015.01.01 to 2019.05.31.The gender,age of first treatment,specific site,classification of hemangioma,total treatment time,total injection times,dosage,tumor size and proportion of blood flow signal in Doppler ultrasound results at reexamination,and adverse events related to disease or treatment before,during and after treatment were recorded in detail.Evaluate the safety and efficacy of the treatment,and the results were taken as the experimental group.The results in the first part were taken as the control group.SPSS 26.0 was used for chi square test to analyze whether the differences between two groups were statistically significant.Results:The first part results:In the 33 literatures included in this study,13 kinds of treatment methods were involved,including surgical treatment(Sur),oral propranolol(OPR),oral glucocorticoid(OGC),injection of Glucocorticoid(InGC),laser therapy(Las),conservative treatment(ConT),cryotherapy(Cry),microwave therapy,injection of Pingyangmycin,injection of anhydrous ethanol,injection of lauromacrogol and topical application of carteolol eye drops.Among them,there are 12 kinds of independent treatment,4 kinds of combination treatment,and there are 9 kinds of treatment methods,which can be treated independently or combined with other methods.Meta-analysis of single group rate was performed for 7 treatments(including at least 3 articles),and the results are as follows(1)The effective rates from high to low:Sur&InGC(90.05%),OPR(85.13%),Las(84.41%),Sur(79.82%),OGC(71.26%),InGC(44.96%);Statistically significant:OPR and OGC,OPR and InGC,Las and InGC,Sur and OPR,Sur and InGC.(2)The cure rates from high to low:OPR(73.05%),Las(71.71%),Sur(34.70%),InGC(21.00%);Statistically significant:OPR and Sur,Las and Sur.(3)The incidence of grade 1-2 adverse events was from low to high:InGC(3.75%),Las(18.91%),OPR(22.56%),Sur(44.96%),Sur&InGC(45.46%),OGC(55.44%),ConT(63.29%);Statistically significant:ConT and OPR,ConT and Las,ConT and InGC,OGC and OPR,OGC and Las,OGC and InGC,Sur and OPR,Sur and Las,Sur and InGC.(4)The incidence of grade≥ 3 adverse events from low to high:OPR(6.12%),OGC(6.85%),ConT(6.85%),Las(12.08%),Sur(14.10%),Sur&InGC(15.16%),InGC(22.98%);The above differences were not statistically significant.The second part results:Among the 46 cases included in this study,the ratio of male to female was about 1:2.54.The total treatment time ranged from 2 to 16 months,and the average treatment time was 9.17 months.There were 1 case(2.17%)with gradeⅠ curative effect,4 cases(8.70%)with grade Ⅱ,10 cases(21.74%)with grade Ⅲ and 31 cases(67.39%)with grade IV.The effective rate(grade Ⅲ and Ⅳ)was 89.13%,and the cure rate(grade Ⅳ)was 67.39%.There were 8 cases(17.39%)of adverse events in all cases,including 7 cases(15.22%)with grade 1-2 adverse events and 1 case(2.17%)with grade≥ 3 adverse events.In the long-term follow-up,in addition to the adverse events related to the disease itself,there was no secondary deformity related to treatment,and no additional damage to the growth and development of the children.The results of this study were compared with the first part(control group).The comprehensive treatment,i.e.oral propranolol combined with local sclerotherapy of lauromacrogol and triamcinolone acetonide,had the second highest effective rate and the lowest incidence of serious adverse events,which means higher safety.And this result may be related to shortening the treatment durationConclusion:The first part conclusion:(1)Positive intervention should be taken in the treatment of infantile nasal hemangioma.(2)In systemic therapy,oral propranolol is more effective and secure.(3)Laser therapy is suitable for children with superficial hemangioma of the nose,with high efficiency and safety.(4)Most of the surgical treatment methods are highly praised by scholars in Europe and America(the countries with a predominantly white population),but the safety is low.(5)Cryotherapy,injection of Pingyangmycin,injection of absolute ethanol and isotope Sr90 irradiation are not recommended in clinical treatment because of their low safety and poor effect.(6)Comprehensive treatment can improve the efficiency and safety to a certain extent.The second part conclusion:For the treatment of children with non-superficial nasal hemangioma,oral propranolol combined with local multi-point injection of lauromacrogol and triamcinolone acetonide can obtain higher efficacy and ensure higher safety,which should be recommended in clinical treatment. |
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