CAJ | 학술논문

目的探讨新生儿颈部大囊型淋巴管畸形介入硬化治疗的疗效及优点.方法回顾性分析2007年7月至2012年7月我院22例新生儿颈部大囊型淋巴管畸形予介入硬化治疗的临床资料,术前均经B型超声、CT或MRI检查诊断为大囊型淋巴管畸形,结合临床特征及术中穿刺抽液进一步证实为淋巴管畸形.全身麻醉下通过B型超声引导经皮穿刺颈部囊性肿物,尽量抽尽囊液后注入平阳霉素,平阳霉素注药时注意让药液在囊内弥散,注药后轻轻揉捏病灶使药液均匀涂布于囊内壁.4周后若患儿未达治愈标准可重复进行,术后随访6～24个月.结果 22例治疗后留置气管插管6～48 h,均顺利拔管,无紧急性或预防性气管切开.本组16例治疗后,影像检查未见病灶或仅有少量残余硬化病灶,经随访无复发,达到治愈标准,其中5例注射2次,9例注射4次,2例注射5次.本组6例瘤体缩小50％以上,影像学检查提示少量囊性病灶残留,达到好转标准,建议其每3～6个月复查一次,必要时再次行介入硬化治疗.总体有效率达100％.22例术后均不同程度出现轻至中度发热、局部肿胀,予对症处理后1 h～2周可恢复正常.本组22例均无过敏、肺纤维化等严重不良反应.结论介入硬化术治疗新生儿颈部大囊型淋巴管畸形,疗程短,创伤小,分次治疗后可达到确切疗效,值得临床推广应用.
목적 탐토신생인경부대낭형림파관기형개입경화치료적료효급우점.방법 회고성분석2007년7월지2012년7월아원22례신생인경부대낭형림파관기형여개입경화치료적림상자료,술전균경B형초성、CT혹MRI검사진단위대낭형림파관기형,결합림상특정급술중천자추액진일보증실위림파관기형.전신마취하통과B형초성인도경피천자경부낭성종물,진량추진낭액후주입평양매소,평양매소주약시주의양약액재낭내미산,주약후경경유날병조사약액균균도포우낭내벽.4주후약환인미체치유표준가중복진행,술후수방6～24개월.결과 22례치료후류치기관삽관6～48 h,균순리발관,무긴급성혹예방성기관절개.본조16례치료후,영상검사미견병조혹부유소량잔여경화병조,경수방무복발,체도치유표준,기중5례주사2차,9례주사4차,2례주사5차.본조6례류체축소50％이상,영상학검사제시소량낭성병조잔류,체도호전표준,건의기매3～6개월복사일차,필요시재차행개입경화치료.총체유효솔체100％.22례술후균불동정도출현경지중도발열、국부종창,여대증처리후1 h～2주가회복정상.본조22례균무과민、폐섬유화등엄중불량반응.결론 개입경화술치료신생인경부대낭형림파관기형,료정단,창상소,분차치료후가체도학절료효,치득림상추엄응용.
Objective To evaluate the effect of interventional sclerotherapy for cervical macrocystic lymphatic malformations in newborns.Methods The clinical data of 22 newborns with cervical macrocystic lymphatic malformations treated between July 2007 and July 2012 in Guangzhou Women and Children's Hospital were retrospectively analysed.Initial diagnosis was made based on physical examination and then confirmed by ultrasound,Computed Tomography or Magnetic Resonance Imaging.Interventional sclerotherapy was used for the newborns under ultrasound guiding.Repeated sclerotherapy was performed for residual cystic lesions.All cases were followed-up from 6 months to 2 years and treatment effects were observed.Results Tracheal intubation was remained for 6 to 48 hours in all patients,whose intubation was removed successfully in all patients without any emergency or preventive tracheotomy.Sixteen patients were cured,six were effectively treated.Five of sixteen patients were treated twice,whereas injections were repeated four times in nine of sixteen patients and five times in two of sixteen patients.All of them suffered from light or mediate fever after the pingyangmycin injection and all cases recovered well after symptomatic treatment Conelusions Interventional sclerotherapy has the superiority in short course of treatment and minimal invasion.It is worthy of clinical application in the treatment of cervical macrocystic lymphatic malformations in newborns.