Wang Ying, Chen Jiarui, Li Xiaoyan
Department of Otolaryngology Head and Neck Surgery，Shanghai Children's Hospital，Shanghai Jiao Tong University，Shanghai，200062，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Mar;36(3):167-171. doi: 10.13201/j.issn.2096-7993.2022.03.002.
To present experience and evaluate the safety and efficacy of surgery combined with bleomycin irrigation for the management of head and neck lymphatic malformations in children. The medical records of all patients with cervical-facial lymphatic malformations who presented to Shanghai Children's Hospital from August 2014 to December 2020 were reviewed. 97 children were divided into surgery group（81 cases） and sclerotherapy group（16 cases）. Conventional contrast-enhanced magnetic resonance imaging（MRI） and B-ultrasound examinations were performed both preoperatively and postoperatively. The surgical group received lymphangioma resection combined with bleomycin irrigation. The sclerotherapy group was treated with B-ultrasound-guided percutaneous lymphangioma aspiration and bleomycin sclerotherapy. SPSS 21.0 software was used to evaluate the clinical cure rate and postoperative complications of lesions in both groups by chi-square test. Kaplan-Meier method was used to calculate the disease-free survival rate and draw survival curve. In the surgery group of 81 children, 64 cases were cured and 17 cases were effective while in the sclerosis group, 8 cases were cured and 8 cases were effective. Cox proportional risk model found that children in the surgery group had a higher cure rate and a lower risk of 5-year recurrence than those in the sclerotherapy group, with statistically significant differences（χ²=5.814, <0.05）. The risk of recurrence in the surgery group was 35.4% of that in the sclerotherapy group（=0.354, <0.05）. In regards to postoperative complications, the surgical group had no higher rate of temporal facial paralysis and other nerve injuries compared to the sclerotherapy group（χ²=1.041, =0.308）. Surgery combined with bleomycin irrigation in the complex cervical-facial lymphatic malformations was confirmed to be effectively and safely. The principle of the surgery was to protect the structure and function of normal tissue while excising the lesions as much as possible. When the lesions involved the posterior two-thirds of the tongue, the floor of the mouth, parapharynx, retropharynx, or hypopharynx spaces. Radiofrequency ablation was used in the surgical excision, which made the surgery more minimally invasive, accurate and personalized.
介绍手术联合博来霉素灌注治疗儿童头颈部淋巴管畸形的经验，并评估其安全性和有效性。回顾了2014年8月至2020年12月在上海儿童医学中心就诊的所有面颈部淋巴管畸形患儿的病历资料。97例患儿分为手术组（81例）和硬化治疗组（16例）。术前和术后均进行常规对比增强磁共振成像（MRI）和B超检查。手术组接受淋巴管瘤切除联合博来霉素灌注。硬化治疗组采用B超引导下经皮淋巴管瘤穿刺抽吸及博来霉素硬化治疗。采用SPSS 21.0软件，通过卡方检验评估两组病变的临床治愈率和术后并发症。采用Kaplan-Meier法计算无病生存率并绘制生存曲线。手术组81例患儿中，治愈64例，有效17例；硬化治疗组治愈8例，有效8例。Cox比例风险模型发现，手术组患儿的治愈率高于硬化治疗组，5年复发风险低于硬化治疗组，差异有统计学意义（χ²=5.814，P<0.05）。手术组的复发风险是硬化治疗组的35.4%（HR=0.354，P<0.05）。在术后并发症方面，手术组与硬化治疗组相比，暂时性面瘫和其他神经损伤的发生率没有更高（χ²=1.041，P=0.308）。手术联合博来霉素灌注治疗复杂的面颈部淋巴管畸形被证实是有效和安全的。手术原则是在尽可能切除病变的同时，保护正常组织的结构和功能。当病变累及舌后三分之二、口底、咽旁、咽后或下咽间隙时，手术切除采用射频消融，使手术更具微创性、精准性和个体化。
