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,2024,(09):841-849.[doi:10.3760/cma.j.cn101785-202307051-008]
儿童网膜淋巴管畸形单中心13年手术治疗回顾
- Title:
- 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
- 摘要:
- 目的 总结儿童网膜淋巴管畸形的临床特点、术前并发症以及手术治疗效果,分析手术方式选择的影响因素。方法 回顾性收集2010年1月至2022年12月首都医科大学附属北京儿童医院普外科手术治疗的76例网膜淋巴管畸形患儿临床资料,并于2023年7月前完成随访。根据术中探查所见囊液性质将患儿分为囊内出血/囊肿感染组和无囊内出血/囊肿感染组,比较两组患儿的临床特点;根据手术入路方式分为开腹手术组和腹腔镜手术组,分析术者选择开腹手术和腹腔镜手术的影响因素。结果 76例患儿中,男46例、女30例;就诊年龄3.4(2.1,5.5)岁;23例(23/76,30.3%)于本院就诊前曾在外院接受保守治疗;畸形长径15.0(10.0,20.0)cm;68例(68/76,89.5%)为大囊型,31例(31/76,40.8%)术前合并囊内出血/囊肿感染。合并囊内出血/囊肿感染者较未合并囊内出血/囊肿感染者出现腹胀的比例更高(16/31比11/45),炎症指标升高人数占比更高(12/19比7/24),囊肿长径≤10 cm人数占比更低(4/26比17/43),差异均有统计学意义(P＜0.05);分别有43例(43/76,56.6%)和33例(33/76,43.4%)接受开腹手术和腹腔镜手术,腹腔镜手术人数呈逐年增加趋势(2010-2012年1例,2013-2015年4例,2016-2018年10例,2019-2022年18例)。多因素分析结果显示,腹痛是影响术者选择腹腔镜手术的最主要因素(OR=3.1,95%CI:1.1~9.0,P=0.032);其次是囊肿长径(OR=0.9,95%CI:0.8~1.0,P=0.049)。腹腔镜手术患儿术后恢复进食时间早于开腹手术,住院时长短于开腹手术,差异均有统计学意义(P＜0.05)。61例(61/76,80.3%)获随访,其中开腹手术组32例,腹腔镜手术组29例;随访时间5.7(3.8,9.5)年;腹腔镜手术与开腹手术相比,术后并发症的发生率差异无统计学意义(3/29比2/32,P＞0.05)。结论 儿童网膜淋巴管畸形术前诊断较为困难,容易出现并发症。出现腹胀、炎症指标升高和囊肿增大时需考虑合并囊内出血/囊肿感染。腹腔镜手术可作为儿童网膜淋巴管畸形的首选手术方式,治疗效果良好。
- 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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备注/Memo
收稿日期:2023-7-26。
通讯作者:陈亚军,Email:chenyajunmd@aliyun.com