摘要
目的探讨儿童复杂及难治型淋巴管畸形（LM）的介入治疗方法。方法回顾性分析2013年1月至2016年1月78例复杂及难治型淋巴管畸形患儿的临床资料，包括颈部28例、颌面部19例、胸部及腋下8例、四肢7例、盆腔及腹膜后6例、上纵隔3例、舌下3例、阴囊及会阴部4例。所有患儿均于术前行超声或MRI等影像检查确诊。（1）经皮穿刺LM囊内硬化治疗，在DSA或彩超引导下用20 G穿刺针穿刺囊腔，并造影确定位置正确，尽可能抽尽其中的囊液后行硬化剂注射治疗。根据囊腔大小调整硬化剂用量，聚桂醇注射液按抽取囊液量的1/10~1/5用量，聚桂醇泡沫总量≤8 ml（20 mg），平阳霉素总量≤8 mg。（2）引流导管置入＋囊内硬化治疗。在超声引导下经皮穿刺或经手术置入引流导管，引流病灶内液体，并保留导管持续引流，分次硬化治疗。（3）采用分期治疗1次/周，2次为一个疗程。每2个疗程间隔4周复查。硬化药物的选择：高张力病灶选择聚桂醇注射液或平阳霉素硬化剂；低张力病灶采用聚桂醇泡沫硬化剂治疗；微囊型病灶采用平阳霉素局部硬化治疗。结果78例患儿共行硬化治疗208疗程，平均（3.0±0.8）疗程/例。其中9例采用聚桂醇泡沫硬化剂治疗，23例采用聚桂醇注射液治疗，39例采用平阳霉素治疗，聚桂醇注射液及平阳霉素联合疗法7例。对于颈部、颌面部，胸部及腋下的高张力病灶，采用聚桂醇原液治疗20例，平阳霉素治疗29例，联合疗法5例。6例盆腔及腹膜后及3例上纵隔的低张力LM采用引流导管置入及聚桂醇泡沫硬化治疗。3例舌下病灶者均为新生儿，选择聚桂醇原液治疗。四肢及阴囊、会阴部病灶以微囊型为主，平阳霉素治疗9例，联合疗法2例。治愈率97.4%（76/78），总有效率为100%（78/78）。经影像检查显示囊腔基本闭合或仅有少量残余硬化病灶，临床检
ObjectiveTo explore the interventional treatment method for complex and refractory lymphatic malformation in children.MethodsThe clinical data of 78 cases with complex and refractory lymphatic malformation during January 2013 to January 2016 in our department were retrospectively analyzed. The lesions involved the neck in 28 cases, maxillofacial regions in 19 cases, the chest and armpit in 8 cases, the limb in 7 cases, the pelvic cavity and retroperitoneal space in 6 cases, the superior mediastinum in 3 cases, the hypogloeeis in 3 cases and scrotum or perineum region in 4 cases. All the children underwent ultrasound or MRI imaging studies preoperatively. The interventional procedures included： （1） Percutaneous puncture of the LM for sclerotherapy. The lesions were punctured with 20 G needle under the guidance of DSA or ultrasound and the correct positions were confirmed with angiography. The liquid of the lesions was extracted as far as possible. The dosage of sclerosing agents was adjusted according to the size of lesion. The dose of Laurolacrogol injection was 1/10—1/5 of the amount of the liquid in the lesions and the maximum of Laurolacrogol foam was ≤8 ml （20 mg） . The dose of Pingyangmycin was ≤8 mg. （2） The drainage catheter placement and sclerotherapy. Percutaneous catheter drainage under ultrasound guidance or by surgery was conducted. The liquid in the lesions was drained by retaining the catheter for 1—4 weeks, and sclerotherapy was applied for several sessions during this period. （3） Treatment for one time a week, 2 times a session. The interval of every two sessions was 4 weeks. The sclerosing agents included： Laurolacrogol Injection or Pingyangmycin for the lesions with high tension, Laurolacrogol foam for the lesions with low tension, Pingyangmycin for the microcystic lesions. Statistical analysis was conducted using SPSS20.0 software.ResultsA total of 208 sessions of sclerotherapy for 78 LM patients were performed and average session was （3.0±0.8） . Nine patients u
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2017年第6期441-445,共5页
Chinese Journal of Radiology
关键词
淋巴管畸形
放射学
介入性
硬化疗法
Lymphatic abnormalities
Radiology,interventional
Sclerotherapy
