Xie Yimin,Nin Jinbo,Yao Mingmu,et al.Effect of hemorrhage of large cystic lymphatic malformation on therapeutic efficacy of sclerotherapy in children[J].Journal of Clinical Pediatric Surgery,2021,20(01):65-68.[doi:10.12260/lcxewkzz.2021.01.013]
囊内出血对儿童大囊型淋巴管畸形硬化治疗效果的影响
- Title:
- Effect of hemorrhage of large cystic lymphatic malformation on therapeutic efficacy of sclerotherapy in children
- Keywords:
- Lymphatic Abnormalities; Sclerotherapy; Lauromacrogol; Child
- 分类号:
- R729;R551.2
- 摘要:
- 目的 探讨儿童大囊型淋巴管畸形并发囊内出血的硬化治疗效果。方法 将重庆大学附属三峡医院儿外科收治的50例儿童大囊型淋巴管畸形患者按是否发生囊内出血分为出血组（22例）和未出血组（28例），术前根据包块发现时间、彩超、MRI及穿刺结果确诊。在彩超引导下抽尽囊液后向囊腔内注射聚桂醇注射液，局部加压包扎2~3天。两周后包块未消失者采用同样的方法进行第二次治疗，直至包块消失为止。观察第一次硬化治疗后及最终包块大小的变化、治疗次数。包块消失判定为显效，包块缩小50%及以上判定为有效，包块缩小50%以下判定为无效。结果 两组均成功进行硬化治疗，第一次治疗后出血组显效4例，有效9例，无效9例，总有效率59.09%；未出血组显效10例，有效14例，无效4例，总有效率85.71%；两组间疗效差异具有统计学意义（χ2=4.539，P<0.05）。最终两组包块均完全消失，有效率均为100%，其中出血组平均治疗（3.55±1.26）次；未出血组平均治疗（2.57±1.35）次，二者比较差异具有统计学意义（t=2.611，P<0.05）。结论 儿童大囊型淋巴管畸形并发囊内出血会降低首次硬化治疗效果，最终疗效满意，但需增加治疗次数。
- Abstract:
- Objective To explore the effect of hemorrhage of large cystic lymphatic malformation on therapeutic efficacy of sclerotherapy in children.Methods Based upon tumor history,color Doppler ultrasound,magnetic resonance imaging (MRI) and puncture result,a total of 50 children of large cystic lymphatic malformation were divided into bleeding group (n=22) and non-bleeding group (n=28).After an aspiration of cystic fluid,an injection of lauromacrogol was performed under the guidance of color Doppler ultrasound.Pressure bandage was applied for 2-3 days and the status of lumps checked after 2 weeks.The same procedure was repeated until the disappearance of lumps.After an initial sclerotherapy,size changes and treatment frequency were recorded.Lump disappearance was judged as excellent,50% or more reduction effective and <50% reduction ineffective.Results After an initial treatment,the outcomes of bleeding group were excellent (n=4),effective (n=9) and ineffective (n=9).The effective rate was 59.09%;the outcomes of non-bleeding group were excellent (n=10),effective (n=14) and ineffective (n=4).The effective rate was 85.71%.There were significant inter-group differences (χ2=4.539,P<0.05).Finally all lumps disappeared with a total effective rate of 100%.The average treatment frequency was (3.55±1.26) in bleeding group versus (2.57±1.35) in non-bleeding group.There were significant inter-group differences(t=2.611,P<0.05).Conclusion Hemorrhage of large cystic lymphatic malformation may reduce the therapeutic effect of sclerotherapy in children.However,in the end lumps were totally disappeared,but the number of treatments was increased.
参考文献/References:
1 马静,毛志勇,娄凡,等.婴幼儿颈面部淋巴管畸形治疗方法的探讨[J].中华耳鼻咽喉头颈外科杂志,2014,49(8):687-689.DOI:10.3760/cma.j.issn.1673-0860.2014.08.013.Ma J,Mao ZY,Lou F,et al.Diagnosis and treatment of faciocervical lymphatic malformations in infants and toddlers[J].Chin J Otorkinolaryngol Head Neck Surg,2014,49(8):687-689.DOI:10.3760/cma.j.issn.1673-0860.2014.08.013.
2 Yetiser S,Karaman K.Treatment of lymphangioma of the face with intalesional bleomycin:case discussion and literature review[J].J Maxillofac Oral Surg,2011,10(2):152-154.DOI:10.1007/ s12663-011-0210-4.
3 谢义民,陈强,王玲,等.聚桂醇瘤腔内注射治疗小儿囊性淋巴管瘤[J].中华小儿外科杂志,2017,38(9):704-707.DOI:10.3760/cma.J.issn.0253-3006.2017.09.012.Xie YM,Chen Q,Wang L,et al.Intratumoral injection of lauromacrogol for children with cystic lymphangioma[J].Chin J Pediatr Surg,2017,38(9):704-707.DOI:10.3760/cma.J.issn.0253-3006.2017.09.012.
4 Colbert SD,Seager L,Haider F,et al.Lymphatic malformations of the head and neck-current concepts in management[J].Br J Oral Maxillofac Surg,2015,51(2):98-102.DOI:10.1016/j.bjoms.2011.016.
5 Elluru RG,Balakrishnan K,Padua HM.Lyphatic malformations:diagnosis and management[J].Semin Pediatr Surg,2014,23(4):178-185.DOI:10.1053/j.sempedsurg.2014.07.002.
6 Motz KM,Nickley KB,Bedwell JR,et al.OK432 versus doxycycline for treatment of macrocystic lymphatic malformations[J].Ann Otol Rhinol Laryngol,2014,123(2):81-88.DOI:10.1177/ 0003489414523561.
7 赵怡芳,赵吉宏.淋巴管畸形的硬化治疗[J].口腔颌面外科杂志,2011,21(1):1-6.DOI:10.3969/j.issn.1005-4979.2011.01.001.Zhao YF,Zhao JH.Sclerotherapy of lymphatic malformations in head and neck[J].Journal of Oral and Maxillofacial Surgery,2011,21(1):1-6.DOI:10.3969/j.issn.1005-4979.2011.01.001.
8 Balakrishnan K,Menezes MD,Chen BS,et al.Primary surgery vs primary sclerotherapy for head and neck lymphatic malformation[J].JAMA Otolaryngol Head Neck Surg,2014,140(1):41-45.DOI:10.1001/jamaoto.2013.5849.
9 Danial C,Tichy AL,Tariq U,et al.An open-label study to evaluate sildenafil for the treatment of lymphatic malformations[J].J Am Acad Dermatol,2014,70(6):1050-1057.DOI:10.1016/j.jaad.2014.02.005.
10 Boardman SJ,Cochrane LA,Roebuck D,et al.Multimodality treatment of pediatric lymphatic malformations of the head and neck using surgery and sclerotherapy[J].Arch Otolaryngol Head Neck Surg,2010,136(3):270-276.DOI:10.1001/archoto.2010.6.
11 Perkins JA,Manning SC,Tempero RM,et al.Lymphatic malformations:review of current treatment[J].Otolaryngol Head Neck Surg,2010,142(6):795-803.DOI:10.1016/j.otohns.2010.02.026.
12 Renton JP,Smith RJ.Current treatment paradigms in the management of lyphatic malformations[J].Laryngoscope,2011,121(1):56-59.DOI:10.1002/lary.20768.
13 Colbert SD,Seager L,Haider F,et al.Lymphatic malformations of the head and neck-current concepts in management[J].Br J Oral Maxillofac Surg,2013,51(2):98-102.DOI:10.1016/j.bjoms.2011.12.016.
14 蒋艳玲,黄文雅,罗勇奇,等.儿童淋巴管畸形44例诊疗分析[J].临床小儿外科杂志,2014,13(5):450-455.DOI:10.3969/j.issn.1671-6353.2014.05.024.Jiang YL,Huang WY,Luo YQ,et al.Diagnosis and treatment of pediatric lymphatic malformations:a report of 44 cases[J].J Clin Ped Sur,2014,13(5):450-455.DOI:10.3969/j.issn.1671-6353.2014.05.024.
15 Parsa CF.Focal venous hypertension as a pathophysiologic mechanism for tissue hypertrophy,port-wine stains,the Sturge-Weber syndrome and related disorders:proof of concept with novel hypothesis for underlying etiological cause (an American Ophthalmological Society thesis)[J].Trans Am Ophthalmol Soc,2013,111:180-215.
16 左海亮,许海华,黄巍,等.沙培林囊内注射治疗儿童淋巴管瘤的疗效观察[J].临床小儿外科杂志,2014,13(4):328-330.DOI:10.3969/j.issn.1671-6353.2014.04.020.Zuo HL,Xu HH,Huang W,et al.Clinical efficacy of treating pediatric lymphangioma with an intracapsular injection of sapylin[J].Journal of Clinical Pediatric Surgery,2014,13(4):328-330.DOI:10.3969/j.issn.1671-6353.2014.04.020.
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备注/Memo
收稿日期:2018-05-24。
基金项目:重庆市卫生计生委医学科研项目（编号：2016MSXM120）
通讯作者:宁金波,Email:xym0309@163.com