背景:虽然哺乳动物雷帕霉素靶抑制剂彻底改变了结节性硬化症(TS)中血管纤维瘤的管理,诸如激光之类的物理疗法仍适用于顽固性病变。
目的:作者对激光治疗与TS相关的面部血管纤维瘤的疗效和安全性进行了系统评价。
方法:电子数据库,如MEDLINE,Embase,PubMed,Cochrane中央控制试验登记册,和WebofScience从开始到2023年10月10日进行了搜索,以查找合格的记录。
结果:47篇文章符合纳入标准,共217例接受激光治疗的TS相关面部血管纤维瘤患者。已经在患者身上试验了几种激光,包括二氧化碳(n=95,43.7%),脉冲染料(n=21,9.7%),氩气(n=16,7.4%),掺钕:钇铝石榴石(n=12,5.5%),铜蒸气(n=9,4.1%),磷酸氧钛钾(n=7,3.2%),铒:钇铝石榴石(n=2,0.9%),激光和各种联合疗法(n=55,25.3%)。
结论:磷酸氧钛钾,脉冲染料,和钕掺杂:钇铝石榴石激光更适合管理血管纤维瘤的血管成分,而消融激光如铒:钇铝石榴石和二氧化碳激光可能为具有突出纤维成分的病变提供更好的选择。虽然几种激光器已经得到了广泛的试验结果,低水平的证据排除了明确的结论,而且没有单一的激光出现优越。
BACKGROUND: While mammalian target of rapamycin inhibitors have revolutionized the management of angiofibroma in tuberous sclerosis complex (TS), physical modalities such as laser are still indicated for recalcitrant lesions.
OBJECTIVE: The authors performed a systematic review of the efficacy and safety of laser treatment for TS-related facial angiofibroma.
METHODS: The electronic databases such as MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to October 10, 2023, for eligible records.
RESULTS: Forty-seven articles met the inclusion criteria, representing a total of 217 patients with TS-related facial angiofibroma who received laser treatment. Several lasers have been trialed in patients including carbon dioxide ( n = 95, 43.7%), pulsed dye ( n = 21, 9.7%), argon ( n = 16, 7.4%), neodymium-doped: yttrium aluminum garnet ( n = 12, 5.5%), copper vapor ( n = 9, 4.1%), potassium titanyl phosphate ( n = 7, 3.2%), erbium: yttrium aluminum garnet ( n = 2, 0.9%), lasers and various combination therapies ( n = 55, 25.3%).
CONCLUSIONS: Potassium titanyl phosphate, pulsed dye, and neodymium-dopsed:yttrium aluminum garnet lasers are better suited to manage the vascular components of angiofibroma while ablative lasers such as erbium: yttrium aluminum garnet and carbon dioxide lasers may present better options for lesions with a prominent fibrous component. While several lasers have been trialed with broadly favorable results, the low level of evidence precludes definitive conclusions, and no single laser appears superior.