摘要
目的回顾性分析介入硬化治疗淋巴管畸形的方法与疗效,探讨淋巴管畸形介入硬化治疗的有效性及安全性。方法收集2016年12月至2019年5月福建省福州儿童医院采用介入硬化治疗的头面颈部、躯干和四肢体表局灶性淋巴管畸形患儿临床资料,回顾其治疗年龄、硬化剂选择及硬化治疗方法。评价治疗前后囊肿体积或大小,评价指标为:优良,体积减小>90%;中等,体积减小>50%;不显著,体积减小<50%;治疗无反应。将优良和中等定义为显著有效。结果29例淋巴管畸形患儿中,巨囊型8例,微囊型8例,混合型13例。平均疗程1.62次,治疗1次18例,治疗2次4例,治疗>2次7例。巨囊型平均治疗1.375次,6例治疗1次;混合型平均治疗1.46次,9例治疗1次;微囊型平均治疗2.13次,治疗均超过2次。随访时间3个月至2年。所有病例治疗优良率为58.7%(17/29),疗效中等率为31%(9/29),不显著率为10.3%(3/29)。巨囊型显著有效率为100%(优良率100%);混合型显著有效率92.3%(优良率53.8%,中等率38.5%);微囊型显著有效率75%(优良率25%,中等率50%)。3种不同类型淋巴管畸形的显著有效率差异无统计学意义(χ2=2.336,P=0.431);对3种不同类型淋巴管畸形的优良率进行比较,差异有统计学意义(χ2=9.77,P=0.009)。巨囊型的优良率明显高于微囊型(P=0.007),混合型优良率与巨囊型(P=0.046)、微囊型(P=0.367)比较均无统计学意义。并发症:2例术后出现发热,3例术后出现囊内出血,2例发生局部色素沉着,1例发生局部感染,无一例出现过敏性休克等全身不良反应或局部组织坏死情况。结论介入硬化治疗淋巴管畸形有显著疗效,其中巨囊型淋巴管畸形疗效最佳,混合型和微囊型次之,且硬化介入治疗的并发症少。介入硬化治疗可作为体表局灶性淋巴管畸形的首要治疗手段。
Objective To explore the clinical protocols and efficacies of lymphatic malformation and examine the efficacy and safety of interventional sclerotherapy for lymphatic malformation.Methods A total of 29 children with focal lymphatic malformations on head,neck,trunk and extremities were recruited.Age of treatment,choice of sclerosing agent and sclerotherapy were reviewed.The volume or size of cyst before and after treatment was evaluated and classified into the following four categories of excellent/volume reduction>90%,medium/volume reduction>50%,insignificant/volume reduction<50%and no response.The fine and medium responses were markedly effective.Results The clinical types were giant cysts(n=8),microcystic(n=8)and mixed(n=13).The average course of treatment was 1.62 times,including once(n=18),twice(n=4)and thrice or more(n=7).The average number of treatments for giant cysts was 1.375 and 6 cases were treated once;the average number of mixed was 1.46 and 9 cases were treated once;the average number of microcapsule was 2.13 and all treated>2 times.The follow-up time after treatment was 3 to 24 months.The excellent rate accounted for 58.7%(17/29),the medium rate 31%(9/29)and the insignificant rate 10.3%(3/29).Among them,giant cystic type had a significant effective rate of 100%(excellent 100%),mixed type 92.3%(excellent 53.8%,medium 38.5%)and microcystic type 75%(excellent 25%,medium 50%).No statistically significant difference in significant effectiveness existed among three types(χ2=2.336,P=0.431).However,the excellent rates of three different types of lymphatic malformations were compared and the difference was statistically significant(χ2=9.77,P=0.009).Further inter-group comparison showed that the excellent rate of giant cystic type was significantly higher than that of microcystic type(P=0.007)and no significant difference existed between mixed and macrocapsule types(P=0.046)or microcapsule type(P=0.367).There were postoperative complications of fever(n=2),intracapsular hemorrhage(n=3),localized hyperpigmentation(n=2)and infection(n=1).And there was no onset of anaphylactic shock or local tissue necrosis.Conclusion Interventional sclerotherapy has a significant effect on lymphatic malformation.The therapeutic efficacy of giant cystic lymphangioma is the best,followed by mixed and microcapsules.With a low incidence of complications,interventional sclerotherapy may used as a primary choice for focal lymphatic malformation.
作者
林向上
邓立才
姚佳星
王涛
陈新弟
王倩
Lin Xiangshang;Deng Licai;Yao Jiaxing;Wang Tao;Chen Xindi;Wang Qian(Fuzhou Children's Hospital of Fujian Province,Fujian 350005,China)
出处
《临床小儿外科杂志》
CAS
2020年第6期518-522,共5页
Journal of Clinical Pediatric Surgery
关键词
淋巴管畸形
超声检查
介入性
硬化疗法
Lymphatic Abnormalities
Ultrasonography,Interventional
Sclerothrapy
