Lin Xiangshang,Deng Licai,Yao Jiaxing,et al.Clinical effects of interventional sclerotherapy for lymphatic malformation[J].Journal of Clinical Pediatric Surgery,2020,19(06):518-522.[doi:10.3969/j.issn.1671-6353.2020.06.011]
淋巴管畸形介入硬化治疗的效果分析
- Title:
- Clinical effects of interventional sclerotherapy for lymphatic malformation
- Keywords:
- Lymphatic Abnormalities; Ultrasonography; Interventional; Sclerothrapy
- 分类号:
- R551.5;R725.5;R733.4
- 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。
- Abstract:
- 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.
参考文献/References:
1 Bhatnagar A,Upadhyaya VD,Kumar B,et al.Aqueous intralesional bleomycin sclerotherapy in lymphatic malformation:Our experience with children and adult[J].Natl J Maxillofac Surg,2017,8(2):130-135.DOI:10.4103/njms.NJMS_6_17.
2 曾振东,刘坤,王少新,等.平阳霉素局部注射治疗头颈部大囊型淋巴管畸形[J].四川医学,2010,31(4):490-491.DOI:10.3969/j.issn.1004-0501.2010.04.033.Zeng ZD,Liu K,Wang SX,et al.Efficacies of local Pingyangmycin injection for large cystic lymphatic malformation in head and neck regions[J].Sichuan Medical Journal,2010,31(4):490-491.DOI:10.3969/j.issn.1004-0501.2010.04.033.
3 Y?lmaz H,Y?lmaz ?,?aml?da?i,et al.Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations[J].Jpn J Radiol,2017,35(10):590-596.DOI:10.1007/s11604-017-0672-5.
4 Yamaki T,Sasaki Y,Hasegawa Y,et al.Percutaneous ultrasound-guided sclerotherapy with polidocanol microfoam for lymphatic malformations[J].J Vasc Surg Venous Lymphat Disord,2017,5(5):707-714.DOI:10.1016/j.jvsv.2017.03.017.
5 Thomas DM,Wieck MM,Grant CN,et al.Doxycycline sclerotherapy is superior in the treatment of pediatric lymphatic malformations[J].J Vasc Interv Radiol,2016,27(12):1846-1856.DOI:10.1016/j.jvir.2016.08.012.
6 Castillo SD,Baselga E,Graupera M,et al.PIK3CA mutations in vascular malformations[J].Curr Opin Hematol,2019,26(3):170-178.DOI:10.1097/MOH.0000000000000496.
7 Waner M,O TM.Multidisciplinary approach to the management of lymphatic malformations of the head and neck[J].Otolaryngol Clin North Am,2018,51(1):159-172.DOI:10.1016/j.otc.2017.09.012.
8 Ozeki M,Asada R,Saito AM,et al.Efficacy and safety of sirolimus treatment for intractable lymphatic anomalies:A study protocol for an open-label,single-arm,multicenter,prospective study (SILA)[J].Regen Ther,2019,10:84-91.DOI:10.1016/j.reth.2018.12.001.
9 Jin L,Chen J,Li X.Surgical excision with bleomycin irrigation:A better primary treatment choice for pediatric submandibular lymphatic malformations[J].J Oral Maxillofac Surg, 2017,75(2):437.e1-437.e7.DOI:10.1016/j.joms.2016.09.041.
10 Chaudry G,Guevara CJ,Rialon KL,et al.Safety and efficacy of bleomycin sclerotherapy for microcystic lymphatic malformation[J].Cardiovasc Intervent Radiol,2014,37(6):1476-1481.DOI:10.1007/s00270-014-0932-z.
11 Wu HW,Wang X,Zheng JW,et al.Treatment of deep-seated facial microcystic lymphatic malformations with intralesional injection of pingyangmycin[J].Medicine,2016,95(37):e4790.DOI:10.1097/MD.0000000000004790.
12 王燕妮,齐鸿燕,张学军.B超引导下微创负压抽吸技术治疗儿童肢体淋巴管畸形的疗效探讨[J].临床小儿外科杂志,2019,18(3):221-224.DOI:10.3969/j.issn.1671-6353.2019.03.012.Wang YN,Qi HY,Zhang XJ.Efficacy of mini-invasive negative pressure aspiration guided by B-ultrasound for extremity lymphatic malformation in children[J].J Clin Ped Sur,2019,18(3):221-224.DOI:10.3969/j.issn.1671-6353.2019.03.012.
13 郭磊,李晓艳,吴长华,等.单帧DSA透视下精准介入硬化术治疗儿童淋巴管畸形疗效观察[J].山东医药,2018,58(13):66-68.DOI:10.3969/j.issn.1002-266X.2018.13.021.Guo L,Li XY,Wu CH,et al.Efficacies of treating pediatric lymphatic malformations with precise interventional sclerotherapy under single-frame digital subtraction angiography[J].Shandong Medical Journal,2018,58(13):66-68.DOI:10.3969/j.issn.1002-266X.2018.13.021.
14 邹运,金云波,陈辉,等.血管瘤和脉管畸形的外科手术治疗[J].皮肤科学通报,2018,35(5):598-603.Zou Y,Jin YB,Chen H,et al.Surgical management of vascular anomalies[J].Chin J Derm Venereol,2018,35(5):598-603.
相似文献/References:
[1]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(06):111.
[2]刘金桥 何静波 陈文娟 陈叶 杨芳 尹海燕.高频超声及彩色多普勒对小儿睾丸肿瘤的诊断价值[J].临床小儿外科杂志,2011,10(02):130.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):130.
[3]李萌,于增文,李索林,等.超声多普勒血管显像在内结扎法腹腔镜脾切除术中的应用[J].临床小儿外科杂志,2008,7(03):4.
[4]解承兰,张兰,傅廷亮,等.胎儿腹部病变的产前诊断及围产期处理[J].临床小儿外科杂志,2007,6(02):5.
[5]刘辉,林琼,傅忠,等.超声诊断先天性肥厚性幽门狭窄20例[J].临床小儿外科杂志,2007,6(02):20.
[6]罗远建,金科,甘青,等.儿童神经母细胞瘤的影像学表现[J].临床小儿外科杂志,2007,6(02):22.
[7]李长春 王珊 章均 欧阳军 孔祥如 杨超 赵珍珍 吕麟亚. B超引导下芯针穿刺活检术诊断儿童实体肿瘤的临床分析[J].临床小儿外科杂志,2011,10(04):247.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):247.
[8]周路遥 何秋明 朱莉玲 张遇乐 贺雪华 符柳江 夏慧敏. 术前超声评估可疑阑尾炎123例分析[J].临床小儿外科杂志,2011,10(04):270.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):270.
[9]陈文娟 段星星 李皓 张雪华 胡原 张号绒. 高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值[J].临床小儿外科杂志,2011,10(05):345.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):345.
[10]张豪 钱蔷英 阮双岁. 424例儿童阴囊内疾病的超声诊断分析[J].临床小儿外科杂志,2011,10(05):357.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):357.
[11]王燕妮,齐鸿燕,张学军.B超引导下微创负压抽吸技术治疗儿童肢体淋巴管畸形的疗效探讨[J].临床小儿外科杂志,2019,18(03):221.[doi:10.3969/j.issn.1671-6353.2019.03.012]
Wang Yanni,Qi Hongyan,Zhang Xuejun.Efficacy of mini-invasive negative pressure aspiration guided by B-ultrasound on limb lymphatic malformation in children[J].Journal of Clinical Pediatric Surgery,2019,18(06):221.[doi:10.3969/j.issn.1671-6353.2019.03.012]
备注/Memo
收稿日期:2019-08-08。
作者简介:林向上,Email:66887151@qq.com