小儿颈面淋巴管瘤的外科治疗

D. Hwang, S. H. Lee, S. Lim, S. Lee, Jeong-Meen Seo
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引用次数: 4

摘要

目的:颈淋巴管瘤是发生于颈部的罕见淋巴血管畸形,可形成巨大的含液囊肿。畸形的治疗包括手术和硬化疗法。然而,最佳方法仍然存在争议。在这里,我们描述了一系列的颈部淋巴管瘤已被治疗的手术途径。方法:回顾性分析2001 ~ 2012年本院诊断为颈面淋巴管瘤的82例患者的病历资料。切除后在手术病灶处放置负压封闭吸引引流管,防止淋巴液再积聚,通过引流管注射OK-432后拔出引流管。结果:12例患者行颈部淋巴管瘤手术切除。手术时患者的中位年龄为3个月。对患者进行了为期34个月的随访。当病变位于气管或颈动脉等重要器官附近或反复注射OK-432无效时,手术治疗可能会带来良好的效果。然而,由于邻近神经损伤引起的吞咽困难、唇部麻痹或发音障碍暂时出现为术后并发症。5例患儿因气管或声门下狭窄行气管造口术,2例患儿术后进食时误吸行胃造口术。结论:颈面部淋巴管瘤的手术治疗应慎重选择。一个经过深思熟虑的多学科外科团队的手术方案,术后放置闭合吸引引流管和通过引流管辅助OK-432硬化治疗似乎有助于获得良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical Treatment of Difficult Cervicofacial Lymphangioma in Children
Purpose: Cervical lymphangiomas are rare lymphovascular malformations arising in the neck, which form huge fluid-containing cysts. Treatment of the malformation consists of surgery and sclerotherapy. However, the optimal approach is still controversial. Here, we describe a series of cervical lymphangiomas which have been treated with surgical approaches. Methods: We retrospectively investigated the medical records of 82 patients who had been diagnosed with cervicofacial lymphangioma from 2001 to 2012 in our center. A closed suction drainage with negative pressure was placed on the operative lesion following excision to prevent reaccumulation of lymphatic fluid and the drainage tube was removed after injecting OK-432 through the tube. Results: Twelve patients underwent surgical excision of cervical lymphangioma. The median patient age was 3 months at the time of the operation. The patients have been followed-up over a period of 34 months. When lesions were located near vital organs such as the trachea or carotid artery or did not respond to repetitive OK-432 injections, surgical treatment might bring good outcomes. However, swallowing difficulty, lip palsy, or dyslalia due to adjacent nerve damage temporarily appeared as postoperative complications. Five children had tracheostomy due to tracheal or subglottic stenosis and 2 patients had gastrostomy due to aspiration while they eat after surgery. Conclusion: Surgery for cervicofacial lymphangioma should be conducted carefully in selective cases. A well thought-out surgical plan with a multidisciplinary surgical team approach and placement of closed suction drainage tube after surgery and adjuvant OK-432 sclerotherapy through drainage tube seem to be helpful for good outcome.
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