单一中心婴幼儿淋巴管畸形治疗的效果分析

Management for lymphatic malformation in infants： a single center experience

目的 探讨临床治疗婴幼儿淋巴管畸形（lymphatic malformations,LM）的效果.方法 回顾性分析2004年6月至2015年7月我中心治疗的996例LM患儿的临床资料,根据治疗方法将患儿分为3组,治疗组1：427例,内镜下LM部分切除＋（贯通）烧灼＋负压吸引术＋无水乙醇注射治疗;治疗组2：239例,单纯平阳霉素＋地塞米松注射治疗;治疗组3：330例,单纯手术切除治疗.比较3组的疗效差异,并选取性别、年龄、瘤体最大径、位置、范围、组织分型及淋巴液性质等参数,分析其与颈面部LM疗效的相关性.结果 3组的治疗有效率比较,差异无统计学意义.治疗组1痊愈333例（78.0％）,治疗组2痊愈165例（69.0％）,治疗组3痊愈238例（72.1％）,治疗组1和治疗组3痊愈率显著高于治疗组2（P＜0.05）.治疗组3的患儿治疗次数明显少于其他2组（P＜0.05）.比较身体不同部位（颈面部、躯干部及四肢）的LM疗效差异,颈面部LM的痊愈率显著低于身体其他部位（P＜0.05）.颈面部LM的疗效在瘤体最大径、范围、分型及淋巴液性质等参数中的比较,差异均有统计学意义（P＜0.05）.多因素Logistic回归分析结果提示,瘤体范围、组织分型可作为颈面部LM疗效差异的独立相关因素,且差异均有统计学意义（P＜0.05）.结论 内镜下LM部分切除＋（贯通）烧灼＋负压吸引术＋无水乙醇注射,以及手术切除均是治疗LM的有效方法,前者相较于其他治疗方式具有微创、术后恢复快且相对比较安全等优势.影响婴幼儿颈面部LM疗效的独立重要因素是组织分型及侵袭范围.

Objective To assess the therapeutic effect of management for lymphatic malformation （LM） in infants.Methods This retrospective study recruited clinical data of 996 patients with LM from June 2004 to July 2015 in our center.All patients were diagnosed as LM after ultrasound,CT or MR scan.All patients were divided into Group 1 （427 patients,treated by endoscopic LM partial resection combined with cautery and postoperative intratumoral negative pressure and absolute ethyl alcohol）,Group 2 （239 patients,treated by combined pinyangmycin and dexamethasone injection）,Group 3 （330 patients,treated by surgical resection only）.The clinical effects were observed in three groups,and therapeutic effect differences in gender,age,maximum diameter,location,range,histological typing,lymph property and treatments were analysed in cervicofacial LM.Results Group 1：333 patients were cured （78.0%）,Group 2：165 patients were cured （69.0%）,Group 3：238 patients were cured （72.1%）.The difference in cure rate between Group 1 and Group 2 or between Group 1 and Group 3 was significant（P 〈0.05）.The number of patients with ≥ 2 treatments in Group 3 was significantly less than that in other two groups.The cure rate of LM in cervicofacial area was significantly lower than that in other parts of body （P 〈 0.05）.In cervicofacial LM patients,the therapeutic effect differences in maximum diameter,range,histological typing,lymph property were statistically significant （P 〈 0.05）.At the multivariable logistic regression analysis,LM range as well as histological typing were independent factors influencing the therapeutic effect （P 〈 0.05）.Conclusions Both treatment of endoscopic LM partial resection combined with cautery and postoperative intratumoral negative pressure and absolute ethyl alcohol,and surgical resection have good therapeutic effect on LM in infants.LM range as well as histological typing are important factors independently influencing the therapeutic effect of cervicofacial LM in infants.