舌微囊型淋巴管畸形分型及疗效的回顾性分析

Retrospective analysis of classification and treatment of microcystic lymphatic malformations of tongue

目的通过回顾性分析舌微囊型淋巴管畸形的临床疗效,探讨舌微囊型淋巴管畸形的临床分型方法,以期为临床提供参考。方法回顾性分析2005年10月至2015年10月临沂市肿瘤医院省级血管瘤特色专科收治的资料完整的舌微囊型淋巴管畸形病例220例,其中男性115例,女性105例;年龄8个月至52岁,中位年龄16岁。所有患者均随访满3年,根据病变临床表现分为局限型(23例)、弥漫型(161例)和巨舌症型(36例)。20例行单纯手术治疗,58例行单纯平阳霉素注射治疗,55例行平阳霉素注射+高频电凝治疗,87例行手术切除+平阳霉素注射治疗。采用4级分级标准评价疗效。对计数资料进行卡方检验,对等级计数资料进行秩和检验。结果局限型病变单纯手术治疗百分率为87.0%(20/23),显著大于其他型病变[0%(0/197)](χ^2=178.060,P<0.001);弥漫型病变平阳霉素注射治疗百分率为100%(161/161),显著大于其他型病变[66.1%(39/59)](χ^2=60.034,P<0.001);巨舌症型病变手术切除+平阳霉素注射治疗百分率为100%(36/36),显著大于其他型病变[27.7%(51/184)](χ^2=65.800,P<0.001)。随访3~13年,疗效Ⅰ级0例,Ⅱ级11例,Ⅲ级50例,Ⅳ级159例。各型病变临床疗效的总体差异有统计学意义(H=158.668,P<0.001);局限型、弥漫型、巨舌症型的Ⅳ级疗效百分率分别为100%(23/23)、82.6%(133/161)和8.3%(3/36)。45例局部黏膜溃疡,经口腔护理及对症治疗后愈合;28例出现发热反应,对症处理后24h恢复正常;16例出现舌系带缩短;12例出现轻度舌体肿胀,6例影响进食,未影响呼吸,治疗后1周自行恢复。结论舌微囊型淋巴管畸形应根据临床分型选择不同的治疗方法。局限型病变建议行单纯手术切除;弥漫型病变行高张力平阳霉素注射,配合手术切除或高频电凝治疗;巨舌症型患者宜采用手术切除配合平阳霉素注射治疗。

Objective To explore the clinical classification of microcystic lymphatic malformations of tongue and observe the treatment of microcystic lymphatic malformations of tongue by retrospective analysis, in order to provide reference for clinical practice. Methods From October 2005 to October 2015, the complete data of 220 cases of microcystic lymphatic malformations of tongue (115 males and 105 females) received and treated in Provincial Special Department of Vascular Anomalies, Linyi Tumor Hospital was analyzed retrospectively. The age ranged from 8 months to 52 years old, with a median age of 16 years old. All patients were followed up for 3 years, and according to their clinical manifestations, they were divided into three types: localized type of 23 cases, diffuse type of 161 cases, and megaloglossia type of 36 cases. Injection with pingyangmycin merely was performed on 58 cases, whereas merely surgery on 20 cases, injection with pingyangmycin combined with high frequency electrocoagulation on 55 cases, and surgery combined with injection with pingyangmycin on 87 cases. The therapeutic effect was evaluated according to the grade 4 standard. The χ^2 test was used for statistical analysis of count data. Rank sum test was used for statistical analysis of ranked data. Results The percentage of surgery merely of localized type was 87.0%(20/23), significantly higher than that of other types of lesions [0%(0/197)](χ^2=178.060, P<0.001). The percentage of injection with pingyangmycin of diffuse type was 100%(161/161), significantly higher than that of other types of lesions [66.1%(39/59)](χ^2=60.034, P<0.001). The percentage of surgery combined with injection with pingyangmycin of megaloglossia type was 100%(36/36), significantly higher than that of other types of lesions [27.7%(51/184)](χ^2=65.800, P<0.001). After follow-ups for 3 to13 years, there were 0 cases of gradeⅠ, 11 cases of grade Ⅱ, 50 cases of grade Ⅲ, and 159 cases of grade Ⅳ. There were statistically significant differences in clinical efficacy among different clinical types (H=158.668, P<0.001). The percentage of level Ⅳ efficacy of localized type, diffuse type and megaloglossia type were 100%(23/23), 82.6%(133/161) and 8.3%(3/36) respectively. Local mucosa ulcer appeared in 45 cases and was cured through oral care and expectant treatment. Fever occurred in 28 cases and returned to normal within 24 h after expectant treatment. The lingual frenum was shortened in 16 cases. There were 12 cases with mild tongue swelling, 6 cases with influence on eating but without influence on breathing, and recovered spontaneously one week later. Conclusions The choice of different treatment methods of microcystic lymphatic malformations of tongue should be made according their clinical classification. The only surgical resection is recommended for localized protrude lesions. Injection with pingyangmycin in high tension combined with surgical resection or high frequency electrocoagulation is effective for diffuse lesions. Surgical resection combined with injection with pingyangmycin is suitable for the patients with megaloglossia type.