颈面部淋巴管瘤的手术时机选择及方法探讨

目的 探讨颈面部淋巴管瘤的手术治疗时机的选择以及手术方法.方法 回顾性分析1990年7月至2008年12月手术治疗的53例颈部淋巴管瘤患者的临床资料,手术时年龄6.5个月-41岁,中位数年龄2.25岁,舌骨上区肿瘤占34%(18/53),舌骨下区占66%(35/53).病灶长径3.3～8.2 cm,平均4.4 cm.77.4%(41/53例)的患者以颈部包块作为惟一症状,手术前出现危及生命的严重并发症9例,分别为:囊内出血2例次、感染而导致囊肿体积迅速增大5例次,呼吸阻塞4例次,吞咽困难2例次.手术前均行颈部超声检查,结合CT检查11例,MRI检查21例.结果 肿瘤完整切除34例,占64.2%,次全切除8例,部分切除11例,部分切除患者于手术后9个月～5年内均有残余或复发病变持续存在,其中舌骨上区7例(7/18),舌骨下区4例(4/35).病变复发或残留的概率在舌骨上区明显高于舌骨下区(χ~2检验,P<0.05).手术后早期并发症包括:面神经下颌支瘫痪1例、Homer's综合征1例、继发性出血1例、腮腺瘘1例、术区积液1例、伤口感染1例、舌体水肿、呼吸道阻塞2例.均经保守治疗痊愈.手术后病理学证实:毛细淋巴管瘤19例,囊性淋巴管瘤34例.结论 颈面部淋巴管瘤的病变所在部位是手术能否成功切除最重要的决定因素.尽管完整的手术切除是治疗理想选择,但如果病变范围较大,邻近累及结构易于损伤,手术不应强求.

Diagnosis and surgical treatment of cervical lymphangioma

Objective To discuss the methods of surgical treatment and their timing choices of cervical lymphangioma. Methods A retrospective review of 53 patients with cervicofacial lymphangioma were treated surgically from July 1990 to December 2008. The age at operation was from 6. 5 months to 41 years old (median age was 2 years old and 3 months). Eighteen (34.0%) lesions were located in the suprahyoid region and 35 ( 66. 0% ) lesions in the infrahyoid region. The diameter of lesion ranged from 3. 3 to 8. 2 cm (average: 4.4 cm). Neck mass was the sole symptom for 77. 4% (41/53) cases. Nine patients presented with life-threatening complications including intracystic hemorrhage in 2 cases/times, infection and rapid increase in tumor size in 5 cases/times, dysphagia in 2 cases/times and respiratory obstruction in 4 cases/times. Color Doppler ultrasound was used to diagnose all patients pre-operatively. Computed tomography (CT) was used in 11 cases and magnetic resonance imaging (MRI) in 21 cases for differential diagnosis. Results The patients were treated by complete resection in 34 cases and subtotal resection in 8 cases. But partial resection in 11 (20. 8% ) cases developed a residual or recurrent lesion within 9 months to 5 years post-operation, including 7 cases in suprahyoid region and 4 cases in infrahyoid region. The rate of residual or recurrent lesions was significantly higher in the suprahyoid region (7/18 ) than that in the infrahyoid region (4/35) ( χ~2,P< 0. 05 ) . The peri-operative complications were paralyses of mandibular branch of facial nerve, Homer's syndrome, secondary hemorrhage, fluid collection at resection site, local infection and parotid fistula in 1 case respectively. Respiratory distress caused by edema of tongue was present in 2 cases. All of them were cured conservatively. The pathological diagnosis was confirmed as capillary lymphangioma in 19 cases and cystic lymphangioma in 34 cases. Conclusion The localization and extent of cervical lymphangioma are the most important determining factors for a successful surgical resection. Although complete excision is the ideal treatment for cervicofacial lymphangioma, this should not be attempted if lesions are too large and neighboring structures liable to injury. The surgeons should be aware of the limitations and potential surgical complications in certain instances.