腹腔镜辅助多西环素注射治疗巨大腹膜后淋巴管畸形

Laparoscopic-assisted doxycycline injection for giant retroperitoneal lymphatic malformation

目的探讨腹腔镜辅助多西环素注射治疗在巨大腹膜后淋巴管畸形(retroperitoneal lymphatic malformation,rLM)中的应用效果。方法回顾性分析2020年7月至2021年7月上海市儿童医院普外科采用腹腔镜辅助多西环素注射治疗的3例巨大rLM患儿临床资料,总结患儿治疗次数及结局,并进行相关文献复习。结果3例中男1例,女2例;年龄2岁2个月至5岁8个月;2例表现为腹痛及腹股沟肿块,1例于体检过程中被发现。3例共进行了5次注射治疗,其中2例治疗2次。病例1治疗后病变最大长径由14.7 cm缩小至4.0 cm,体积缩小约95.2%;病例2治疗后病变最大长径由11.8 cm缩小至5.5 cm,体积缩小约95%;病例3治疗后病变最大长径由9.0 cm缩小至2.5 cm,体积缩小约98.9%。3例均达到治愈标准且症状消失。1例术后出现呕吐,自行缓解。随访6~12个月未见复发及其他并发症。结论多西环素注射治疗巨大rLM疗效显著,安全性高,可作为临床治疗rLM的优先选择。腹腔镜辅助下治疗巨大rLM创伤小,可提高注射精准度,减少并发症的发生。

Objective To explore the application of laparoscopic-assisted sclerotherapy for giant retroperitoneal lymphatic malformation(rLM).Methods From July 2020 to July 2021,retrospective review was conducted for clinical data of 3 children with giant retroperitoneal lymphatic malformation receiving laparoscopic-assisted doxycycline injection.And the relevant literature was retrived for discuss the approaches of injection therapy,efficacy and cautions.Results There were 1 boy and 2 girls with an age range of(26-68)month.Two cases presented with abdominal pain and inguinal masses.A total of 5 injections were performed and 2 cases treated twice.In case No.1,the maximal diameter of lesion decreased from 14.7 to 4.0 cm after treatment with a volume reduction of 95.2%;In case No.2,the maximal diameter of lesion dropped from 11.8 to 5.5 cm after treatment with a volume reduction of 95%;In case No.3,the maximal diameter of lesion declined from 9.0 to 2.5 cm after treatment with a volume reduction of 98.9%.All of them reached the standard of cure and the symptoms disappeared.Only one case of postoperative vomiting resolved spontaneously.No recurrence or other complications were observed during a follow-up period of(6-12)months.Conclusions Sclerotherapy injection for gaint retroperitoneal lymphatic malformation has a marked efficacy and a high safety.And laparoscopic assistance may offer minimal invasion,improve accuracy of injection and reduce complications.