延迟单侧头颈部淋巴管畸形的侵入性治疗可改善预后。
Delaying Invasive Treatment in Unilateral Head and Neck Lymphatic Malformation Improves Outcomes.
作者信息
Bonilla-Velez Juliana, Whitlock Kathryn B, Ganti Sheila, Shivaram Giri M, Bly Randall A, Dahl John P, Manning Scott C, Perkins Jonathan A
机构信息
Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A.
出版信息
Laryngoscope. 2023 Apr;133(4):956-962. doi: 10.1002/lary.30237. Epub 2022 Jun 3.
OBJECTIVES
Large (De Serres stage [IV-V]) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number.
MATERIALS
Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0-18 years.
METHODS
ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0-1), acceptable (2-5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ ). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT).
RESULTS
Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0-45 m) with 107/199(54%) male. HNLM were stage I-III (174 [88%]), IV-V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV-V, oral location, and tracheotomy (p < 0.001). Stage I-III HNLMs were initially observed compared with stage I-III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., >1 IT], RR = 0.09, 95% CI 0.02-0.36, p < 0.001). Stage I-III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV-V (RR = 0.47, 95% CI 0.33-0.66, p < 0.001).
CONCLUSION
Observation and delayed IT in stage I-III HNLM ("Grade 1") is safe and reduces IT (i.e., ≤1 IT). Stage IV-V HNLMs ("Grade 2") with early IT have a greater risk of multiple ITs.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:956-962, 2023.
目的
大型（德塞尔阶段[IV - V]）头颈部淋巴管畸形（HNLMs）通常需要多种高风险的侵入性治疗（ITs）来解决功能受损问题。从逻辑上讲，减少HNLMs的ITs应能降低治疗风险。我们测试了延迟HNLMs的ITs是否会减少总的IT数量。
材料
2010年至2017年间连续纳入的199例年龄在0至18岁的HNLMs患者。
方法
针对导致HNLMs持续存在或功能障碍的情况提供ITs（手术或硬化治疗）。根据IT数量对治疗效果进行分类：最佳（0 - 1次）、可接受（2 - 5次）或次优（>5次）。总结临床数据并测试结果关联（χ检验）。使用泊松工作模型的相对风险（RR）测试HNLMs观察或IT延迟（诊断后>6个月）是否能预测治疗成功（即≤1次IT）。
结果
HNLMs诊断时的中位年龄为1.3个月（四分位间距[IQR] 0 - 45个月），107/199（54%）为男性。HNLMs为I - III期（174例[88%]），IV - V期（25例[13%]）。初始治疗为观察（70例[35%]），侵入性治疗（129例[65%]）。治疗结果为最佳（137例[69%]）、可接受（36例[18%]）和次优（26例[13%]）。次优结果关联因素：EXIT手术、IV - V期、口腔部位和气管切开术（p < 0.001）。与在HNLMs诊断后6个月内接受ITs的I - III期患者相比，I - III期HNLMs最初接受观察的患者相对治疗失败风险降低了82%（即>1次IT，RR = 0.09，95% CI 0.02 - 0.36，p < 0.001）。与IV - V期相比，I - III期HNLMs未延迟ITs的患者治疗失败风险降低（RR = 0.47，95% CI 0.33 - 0.66，p < 0.001）。
结论
I - III期HNLMs（“1级”）的观察和延迟IT是安全的，并能减少IT次数（即≤1次IT）。早期接受ITs的IV - V期HNLMs（“2级”）有更高的多次ITs风险。
证据水平
4 喉镜，133:956 - 962，2023年
Zotero 插件