Wang Shengcai, Du Jiangnan, Liu Yuanhu, Zhang Jie, Ge Wentong, Zhang Yamei, Guo Yongli, Li Yanzhen, Zhang Xuexi, Li Xiaodan, Yu Yongbo, Jin Yaqiong, He Yuzhu, Shi Jin, Tai Jun, Ni Xin
a Department of Otolaryngology, Head and Neck Surgery , Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH) , Beijing , China.
b Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University , National Center for Children's Health (NCCH) , Beijing , China.
Acta Otolaryngol. 2019 Aug;139(8):713-719. doi: 10.1080/00016489.2019.1616818. Epub 2019 Jun 6.
Lymphatic malformations (LMs) are caused due to abnormal lymphatic development, and mainly occur in neonates or young children. At present, the role of surgery in the treatment of head and neck LMs is still controversial, focusing mainly on surgical efficacy and indications. This study aimed to explore the effect and influential factors of surgical treatment in children with head and neck LMs, hoping to provide a basis for rational selection of surgical indications. This retrospective study enrolled 128 children with head and neck LMs and underwent surgical treatment in Beijing Children's Hospital from May 2007 to June 2016. They were classified into three morphological groups: macrocystic, microcystic, and mixed. Based on de Serres staging, they were divided into five groups: stage I to V. The local lesion control rate, complication rate, and recurrence rate were summarized and analyzed. The rate of completely controlled and almost completely controlled in cases with head and neck LMs was 71.1%. The postoperative complication rate was 13.3%, and the postoperative recurrence rate was 11.9%. Statistically significant difference was found for local lesion control and postoperative recurrence rates between different morphological and clinical staging groups. Furthermore, the complication rate showed a significant difference between different morphological groups, but not between clinical staging groups. Surgical resection in children with macrocystic, low-stage, or neck-limited LMs demonstrated better therapeutic effect, with fewer complications. However, the effect remained poor and had more complications for microcystic, diffused and high-stage patients. High stage and incomplete resection are considered as the main factors for postoperative recurrence. Current staging system for LMs has important predictive value in the prognosis of head and neck LMs. For LMs in posterior pharyngeal space, plasma ablation has certain advantages.
淋巴管畸形（LMs）是由淋巴管发育异常引起的，主要发生于新生儿或幼儿。目前，手术在头颈部淋巴管畸形治疗中的作用仍存在争议，主要集中在手术疗效和适应证方面。本研究旨在探讨手术治疗儿童头颈部淋巴管畸形的效果及影响因素，以期为合理选择手术适应证提供依据。本回顾性研究纳入了2007年5月至2016年6月在北京儿童医院接受手术治疗的128名头颈部淋巴管畸形患儿。他们被分为三种形态学类型：大囊型、微囊型和混合型。根据de Serres分期，他们被分为五组：I期至V期。总结并分析局部病变控制率、并发症发生率和复发率。头颈部淋巴管畸形患儿的完全控制率和几乎完全控制率为71.1%。术后并发症发生率为13.3%，术后复发率为11.9%。不同形态学和临床分期组之间在局部病变控制和术后复发率方面存在统计学显著差异。此外，不同形态学组之间并发症发生率存在显著差异，但临床分期组之间无显著差异。大囊型、低分期或局限于颈部的淋巴管畸形患儿进行手术切除显示出较好的治疗效果，并发症较少。然而，微囊型、弥漫型和高分期患者的效果仍然较差且并发症较多。高分期和切除不完全被认为是术后复发的主要因素。目前的淋巴管畸形分期系统对头颈部淋巴管畸形的预后具有重要的预测价值。对于咽后间隙的淋巴管畸形，等离子消融有一定优势。
