婴幼儿颈面部淋巴管畸形治疗方法的探讨

Diagnosis and treatment of faciocervical lymphatic malformations in infant

目的 探讨婴幼儿颈面部淋巴管畸形的治疗方法.方法 分析2009年1月至2013年12月共收治确诊的46例婴幼儿淋巴管畸形的临床资料,男26例,女20例;年龄9个月～4岁,中位数1.8岁,治疗前行影像学检查,了解肿块位置、大小和毗邻.结果 46例中28例大囊型患儿采用Ⅰ期手术,完整切除7例,绝大部分切除21例;10例微囊型和8例巨大瘤体（最大径≥10 cm）,包绕颈动静脉,采用低浓度平阳霉素注射,12例明显消退,6例消退不明显（2例微囊型,4例巨大型）半年后Ⅱ期手术切除.术后愈合良好,术后2例出现面神经下颌缘支和副神经损伤,致口角偏斜和右上肢抬举无力,康复治疗好转.结论 手术治疗是淋巴管畸形的有效治疗方法,为避免并发症发生,对于微囊型及特别巨大的淋巴管畸形可给予穿刺抽液后注射平阳霉素,无效时予Ⅱ期手术切除.

Objective To discuss the treatment effect of infant lymphatic malformations （LMs） located in the head and neck.Methods Fourty-six LMs located in the head and neck between 2009 and 2013 were retrospectively analyzed.There were 26 males and 20 females,aged from 9 months to 4 years,with a median age of 1.8 years.Results Phase Ⅰ surgical resection was performed in 28 cases.The low concentrations of pingyangmycin was injected in 18 cases,and Phase Ⅱ surgical resection was performed in 6 cases after 6 months,because of the large tumors and a wide range of invasion.Two post-operative complications were found,one was minor paralyses of mandibular branch of facial nerve,manifestied as mouth askew.Another was injured accessory nerve,manifestied as right upper limb lifting weakness,which improved after rehabilitation treatment.Conclusions Surgical treatment is effective to LMs.In order to avoid serious complications,the huge LMs and microcystic LMs may be given local injection of pingyangmycin after puncture fluid,and phase Ⅱ surgical resection secondly if necessary.