婴幼儿颈胸部淋巴管畸形的介入硬化治疗

目的探讨婴幼儿颈胸部淋巴管畸形介入硬化治疗的疗效及优点。方法回顾我院2013年10月~2015年12月共确诊治疗29例婴幼儿颈胸部淋巴管畸形的临床资料,男10例,女19例;年龄2个月~3岁,平均3个月龄,治疗前行超声、CT或MRI诊断为淋巴管畸形,并根据检查结果对淋巴管畸形予以分型,明确与周围血管及重要器官毗邻关系。术中抽取囊液为淡黄色或血色,注入平阳霉素(或博莱霉素),在DSA透视和/或超声引导下,使药物在瘤体内均匀的扩散,完成硬化治疗。术后1个月复查,并根据硬化效果决定是否行多次硬化治疗。结果介入硬化治疗小儿体表淋巴管畸形的总体有效率为100%。本组29例患儿,其中11例大囊型淋巴管畸形患儿行一次介入硬化治疗;13例患儿行两次介入硬化治疗;4例行三次介入硬化治疗,均达到治愈标准。1例行六次介入硬化治疗后瘤体缩小至30%,治疗有效。17例患儿术后局部肿胀,3例出现术后发热,分别给予对症处理。本组均未出现肺炎样病变和肺部纤维化严重不良反应。结论小儿颈胸部淋巴管畸形介入硬化治疗有效、安全,注射药物存留在囊腔内,术后药物持续作用于病灶时间长且并发症明显减少。

Interventional treatment of cervical and thoracic lymphatic malformations in infants and young children

Objective To investigate the method, curative effect and advantages of interventional therapy for infants and young children with cervical and thoracic lymphatic malformations. Methods The clinical records of 29 infants and young children (10 boys, 19 girls; mean age: 3 months; range: 2 months-3 years) with cervical and thoracic lymphatic malformations from October 2013 to December 2015 were reviewed. The type and size of the lymphatic malformation as well as its relationship with the adjacent organs and vessels were evaluated by ultrasound,.CT and MRI..Pale yellow or hemorrhagic fluid was aspirated and sclerosing agent was injected under the guidance of ultrasound or digital subtraction angiography. Sclerotherapy was repeated, when necessary at 1-month follow-up. Results Sclerotherapy was effective in all 29 infants and children after 1 (11), 2 (13), 3 (4), or 6 (1) treatments with >70% volume reduction. Post-treatment complications included local swelling (17) and fever (3). There were no serious adverse reactions such as pulmonary inflammation and fibrosis. Conclusion Percutaneous sclerotherapy is effective and safe for treatment of cervical and thoracic lymphatic malformations in infants and young children.