儿童头颈部淋巴管畸形的外科治疗

Surgical treatment of lymphatic malformation located in head and neck in children

目的探讨儿童头颈部淋巴管畸形的外科治疗方法和疗效。方法回顾性总结北京大学第一医院自1998年1月至2008年12月住院治疗的11例儿童短径大于4em的头颈部淋巴管畸形。11例儿童头颈部淋巴管畸形均行增强CT或MRI扫描检查，治疗均采用外科手术治疗，其中行肿物及腮腺浅叶切除4例，肿物及腮腺全切除2例，颈清扫术式切除肿物2例，颈清扫术式联合开胸术切除肿物1例，颌下肿物切除术2例。术中采用假包膜外剥离法及顺行解剖面神经主干法，肿物与面神经粘连紧密的2例行肿物剔除术。其中6例行外周面神经解剖，2例行面神经下颌缘支解剖。结果11例儿童头颈部肿物均彻底切除，无器官功能异常，无明显外形变化，治愈率为100％。3例在行面神经下颌缘支解剖和肿物切除时牵拉下颌缘支出现轻度面瘫（下颌缘支力弱），1例颈部广泛肿物行颈清扫术后出现Homer综合征，均在神经营养治疗后术后1—3个月内恢复。1例1岁患儿行颈清扫术式联合开胸术切除肿物的术中输血150ml。所有病例随访6～121个月，随访中位数32个月，未见肿物复发。结论采用面神经解剖及（或）颈部解剖、肿物假包膜外剥离法等手术可以根治儿童头颈部大型淋巴管畸形，是保留功能、防止畸形的有效方法。

Objective To evaluate the surgical approaches and therapeutic effect of lymphatic malformations located in head and neck in children. Methods Eleven cases of lymphatic malformations in the region of head and neck in children encountered between Jan. 1998 and Dec. 2008 in Peking University First Hospital were retrospectively analyzed. Initial diagnosis was made based on the physical examination and then confirmed by MR and Enhanced CT imaging. Surgical therapy was used for patients with lymphatic malformation which exceeds 4 cm. The operative technique was as follows： mass resection and superficial parotidectomy （4 cases ）, mass resection and total parotidectomy （2 cases ）, mass resection with neck dissection （2 cases）, mass resection with neck dissection and sternotomy （1 case）, marginal mandibular branch of facial nerve dissection and mass resection （2 cases）. Dissection outside the false capsule was applied during the operation and facial nerve was dissected from bole to terminal arborization. Results The mass was completely removed in all 11 cases without organ dysfunction and obvious dysfigurement. The cure rate was 100%. Three cases suffered from a branch of facial nerve paralysis because of tension and 1 case had a Homer＇s syndrome after operation. One case needed a blood transfusion （150 ml） during the operation. All cases have been followed up with excellent results from 6 to 121 months, 32 months of the median, no mass recurrence. Conclusions Dissection outside the false capsule of mass and dissection of facial nerve were applied in the surgical treatment of huge lymphatic malformations. These methods are effective in the preservation of function and avoidance of abnormality.