Yan Jiayu,Pang Wenbo,Zhang Dan,et al.Surgery for omental lymphatic malformations in children: a single-center experience of 13 years[J].Journal of Clinical Pediatric Surgery,,():841-849.[doi:10.3760/cma.j.cn101785-202307051-008]
Surgery for omental lymphatic malformations in children: a single-center experience of 13 years
- Keywords:
- Lymphatic Abnormalities; Omentum; Surgical Procedures; Operative; Laparoscopy; Postoperative Complications; Child
- Abstract:
- Objective To summarize the clinical characteristics,preoperative complications and clinical outcomes of omental lymphatic malformations (OLMs) in children and examine the influencing factors of selecting surgical approaches. Methods From January 2010 to December 2022,the relevant clinical data were retrospectively reviewed for 76 OLMs children.Follow-ups were conducted until July 2023.Based upon cyst contents,they were assigned into subjects with or without preoperative hemorrhage or infection.And their clinical characteristics were compared.Also laparotomy and laparoscopy groups were selected.And the influencing factors of selecting laparotomy or laparoscopy were examined. Results There were 46 boys and 30 girls with an average age of 3.4(2.1,5.5) years.Twenty-three children (23/76,30.3%) received conservative treatments at other hospitals.The median diameter of cysts was 15.0(10.0,20.0) cm and macrocystic type accounted for 89.5%.And 31(31/76,40.8%) developed preoperative hemorrhage or infection of cyst.Those with preoperative hemorrhage or infection of cyst had a higher proportion of abdominal distension (16/31 vs.11/45,P=0.015),a higher proportion of elevated inflammatory markers (12/19 vs. 7/24,P=0.026) and a lower proportion of cyst with a diameter ≤10 cm (4/26 vs.17/43,P=0.044).And 43(43/76,56.6%) and 33(33/76,43.4%) underwent open surgery and laparoscopy respectively and the number of laparoscopy spiked markedly yearly (1 from 2010 to 2012,4 from 2013 to 2015,10 from 2016 to 2018 & 18 from 2019 to 2022).Abdominal pain was the most important influencing factor for selecting laparoscopy (OR=3.1; 95%CI,1.1-9.0;P=0.032) and it was followed by cyst size (OR=0.9; 95%CI,0.8-1.0;P=0.049).Those undergoing laparoscopy started ingestion earlier (1.0vs.2.0day,P=0.001) with a shorter hospital stay.A total of 61 children (61/76,80.3%) (open surgery,n=32 vs laparoscopy,n=29) were followed up with an average period of 5.7(3.8,9.5) year and 5 cases (5/61,8.2%) developed postoperative complications.No significant difference existed in the incidence of postoperative complications between laparoscopy and open surgery (3/29 vs.2/32,P=0.662). Conclusions OLMs in children are challenging to diagnose preoperatively and are more prone to complications.Abdominal distension,elevated inflammatory markers and massive cyst may hint at hemorrhage or infection of cyst.Laparoscopy is a preferred treatment with excellent outcomes for OLMs in children.
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Memo
收稿日期:2023-7-26。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com