纤维蛋白胶联合OK-432和博来霉素经皮硬化治疗头颈部大囊型淋巴管畸形

Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the head and neck using fibrin glue with OK-432 and bleomycin

目的:评估纤维蛋白胶联合OK-432和博来霉素治疗头颈部大囊型淋巴管畸形的临床效果。方法 :回顾分析15例经皮硬化治疗巨大淋巴管畸形患者,男6例、女9例,年龄13个月～14岁(平均6.1岁)。治疗区域包括颈部(6例)、腮腺区和咽旁(4例)、口底(2例)、面颊部(2例)和眶区(1例)。病变大小4 cm×5 cm～12 cm×16 cm(平均7.7cm×9.5 cm)。全麻下注射纤维蛋白胶和OK-432、博来霉素混合物。术前、术后采用CT扫描,并由3名口腔颌面外科医师组成的小组评估其治疗效果。结果:术后3～4周面部肿胀,无其他严重并发症。随访8～16个月(平均11.5个月),8处病变完全治愈,5处大部分治愈,2处部分治愈。结论:纤维蛋白胶联合OK-432和博来霉素经皮硬化治疗头颈部大囊型淋巴管畸形是一种安全、可靠的治疗手段。

PURPOSE： Picibanil（OK-432） and bleomycin have been used as alternative sclerosing agents for lymphatic malformations.The purpose of the study is to evaluate the clinical curative effect of sclerotherapy using fibrin glue combined with OK-432 and bleomycin for the treatment of macrocystic lymphatic malformations of the head and neck.METHODS： We conducted a retrospective review of 15 pediatric patients who had received percutaneous sclerotherapy for massive macrocystic lymphatic malformations of the head and neck.The study group included six males and nine females,aged 13 months to 14 years（mean,6.1 years）.Affected regions included the neck（n=6）,parotid region and parapharynx（n=4）,floor of mouth（n=2）,face and cheek（n=2）,and orbital regions（n=1）.All patients showed preoperative symptoms of space-occupying lesions between 4 cm×5 cm and 12 cm×16 cm in size（mean 7.7 cm×9.5 cm）.Fibrin glue with OK-432 and bleomycin was injected under general anesthesia.All patients received preoperative and follow-up computed tomography scans.Outcomes were assessed by a panel of three oral and maxillofacial surgeons.RESULTS： All patients exhibited mid-facial swelling for 3 to 4 weeks after treatment,but no major complications occurred.Follow-up periods ranged from 8 to 16 months（mean,11.5 months）.Eight lesions were completely cleared,five lesions were almost cleared,and two lesions were partially cleared.CONCLUSION： Percutaneous sclerotherapy using fibrin glue with OK-432 and bleomycin provided a simple,safe,and reliable alternative treatment for massive macrocystic lymphatic malformations of the head and neck.