Zhang Hao,Ji Yi,Chen Jianbing,et al.Intralesional Nd: YAG Laser photocoagulation in the treatment of pediatric lymphatic malformations: clinical observations of 18 cases[J].Journal of Clinical Pediatric Surgery,2021,20(09):871-875.[doi:10.12260/lcxewkzz.2021.09.014]
Nd:YAG激光光纤治疗儿童淋巴管畸形18例
- Title:
- Intralesional Nd: YAG Laser photocoagulation in the treatment of pediatric lymphatic malformations: clinical observations of 18 cases
- Keywords:
- Lymphatic Abnormalities/TH; Lasers; Solid-State; Treatment Outcome; Child
- 分类号:
- R726.547.2;R454.21
- 摘要:
- 目的 探讨采用Nd：YAG激光光纤治疗儿童躯干及四肢部位淋巴管畸形的疗效。方法 选择南京医科大学附属儿童医院2018年1月至2019年1月收住入院的18例体表淋巴管畸形患者作为研究对象，术前均行MRI及B超检查，采用光纤插入法进行激光内照射治疗。每3个月治疗一次，重复治疗3次，术后早期持续穿戴弹力裤或绷带。18例均接受3次光纤治疗，疗程结束后进行评估，疗效欠佳者可选择其他方法治疗，随访1~2年。结果 18例中3例淋巴管畸形改善不明显，选择手术治疗。其余15例经激光内照射治疗后，淋巴管畸形明显缩小甚至消失，无一例畸形范围继续增大，有效率为83.3%。6例瘤体未完全消失者每6个月到1年病灶内注射聚桂醇1次，其中4例注射2次，1例注射3次，1例注射4次。10例病灶位于肢体或腋下的患儿中，其中7例病灶位于肢体的患者肢体周径较治疗前缩小平均3.7 cm，3例病灶位于腋下的患者胸围径较治疗前缩小平均4.03 cm。治疗前患肢与健侧平均差值为4.7 cm；经治疗后，平均差值缩减为2.23 cm。治疗前位于腋下的患侧与健侧平均差值为5.2 cm；经治疗后，平均差值缩减为1.17 cm。18例治疗过程中均无明显不良反应。结论 Nd：YAG激光光纤治疗儿童躯干及四肢部位淋巴管畸形安全可行，有较大的临床应用价值。
- Abstract:
- Objective To explore the efficacy of interstitial Nd:YAG photocoagulation for cavernous lymphatic malformations in children.Methods A retrospective review was performed for 18 children of cavernous lymphatic malformations from January 2018 to January 2019.Magnetic resonance imaging (MRI) and ultrasonography were performed for preoperative evaluations of affected areas.Nd:YAG laser was delivered through an optical fiber.Three sessions were required at an interval of 3 months.Elastic pant or bandage was applied under pressure to suppress tumor growth over 6 months after an initial treatment.The efficacy evaluations were made and other alternative treatments applied for cases of poor efficacy.The follow-up period was 1-2 years.Results Because the improvement of the lymphatic malformation was not obvious, there were 3 children who chose surgical treatment. In 15 cases, there were obvious changes, and no further enlargement, the effective rate was 83%. 6 cases with completely uncontrolled tumors were injected poly cinnamyl alcohol once six months to once year, among which 4 cases were 2 times, 1case were 3 times, 1 case were 4 times. Among the 10 cases with lesions located in limbs or armpits, the circumference diameter of 7 cases located in limbs was reduced by 3.7 cm on average, and the chest diameter of 3 cases located in armpits was reduced by 4.03 cm on average. And the average difference between the affected limb and the healthy side before treatment was 4.7 cm.After treatment, the mean was reduced to 2.23 cm. And the average difference between the affected armpit and the healthy side before treatment was 5.2 cm.After treatment, the mean was reduced to 1.17 cm.No further increase was found. Muscle strength was normal and activity of the limbs was not significantly abnormal. Conclusion Intralesional Nd:YAG laser photocoagulation is an effective and safe treatment for cavernous lymphatic malformations.
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备注/Memo
收稿日期:2020-08-24。
通讯作者:沈卫民,Email:swmswmswm@sina.com