CAJ | 학술논문

目的探讨硬化疗法(平阳霉素联合曲安奈德瘤体内注射治疗)治疗婴幼儿颈面部巨大淋巴管畸形的疗效及优点.方法回顾性分析昆明市儿童医院耳鼻咽喉头颈外科2009年1月至2014年6月收治确诊的67例婴幼儿巨大淋巴管畸形的临床资料,男35例,女32例;年龄1个月～4岁,中位年龄1.3岁.患儿治疗前均行B超、CT检查,了解肿块位置、大小和毗邻.病变范围最小5.2 cm ×7.5 cm,最大9.2 cm×10.5 cm.全身麻醉下通过B型超声引导经皮穿刺颈部囊性肿物,尽可能抽尽囊液后注入1 g/L平阳霉素和曲安奈德混合液,根据病变情况决定治疗的次数,2次治疗间隔30 d.结果 67例患儿,注射平阳霉素和曲安奈德混合液2～5次,中位次数3.9次.随访5～ 36个月,治愈42例(62.68％),有效19例(28.36％),无效6例(8.96％),总有效率为91.04％.无严重变应反应和肺纤维化发生.12例疗效不佳患儿6个月后行Ⅱ期手术,术后出现2例轻度口角歪斜和1例声音嘶哑,经对症治疗后好转.术后随访12个月以上,未见瘤体复发.结论分次硬化疗法治疗婴幼儿巨大淋巴管畸形疗效确切,具有创伤小、疗程短的优点,可避免严重的并发症发生.治疗无效时再考虑Ⅱ期手术,手术风险和合并症亦未见明显增加.
목적 탐토경화요법(평양매소연합곡안내덕류체내주사치료)치료영유인경면부거대림파관기형적료효급우점.방법 회고성분석곤명시인동의원이비인후두경외과2009년1월지2014년6월수치학진적67례영유인거대림파관기형적림상자료,남35례,녀32례;년령1개월～4세,중위년령1.3세.환인치료전균행B초、CT검사,료해종괴위치、대소화비린.병변범위최소5.2 cm ×7.5 cm,최대9.2 cm×10.5 cm.전신마취하통과B형초성인도경피천자경부낭성종물,진가능추진낭액후주입1 g/L평양매소화곡안내덕혼합액,근거병변정황결정치료적차수,2차치료간격30 d.결과 67례환인,주사평양매소화곡안내덕혼합액2～5차,중위차수3.9차.수방5～ 36개월,치유42례(62.68％),유효19례(28.36％),무효6례(8.96％),총유효솔위91.04％.무엄중변응반응화폐섬유화발생.12례료효불가환인6개월후행Ⅱ기수술,술후출현2례경도구각왜사화1례성음시아,경대증치료후호전.술후수방12개월이상,미견류체복발.결론 분차경화요법치료영유인거대림파관기형료효학절,구유창상소、료정단적우점,가피면엄중적병발증발생.치료무효시재고필Ⅱ기수술,수술풍험화합병증역미견명현증가.
Objective To investigate the therapeutic effect of Pingyangmycin combined with Triamcinolone Acetonide on the huge faciocervical lymphatic malformations (LMs) in infants.Methods Sixty-seven infants with LMs located in head and neck from January 2009 to June 2014 were retrospectively analyzed in Kunming Children's Hospital.Thirty-five males and 32 females were enrolled,aged from 1 month to 4 years,with a median age of 1.3 years.Computed tomography and ultrasonography were used to evaluate the location,size and extent of LMs before treatment in all the patients.The size of lesion varied from 5.2 cm ×7.5 cm to 9.2 cm × 10.5 cm.All patients were given local injection of Pingyangmycin combined with Triamcinolone Acetonide after puncturing fluid with uhrasonography guiding under general anesthesia.The injection was repeated every 30 d when necessary.Results The number of injections varied from 2 to 5 times,with a median number of 3.9 times.All cases were followed up for 5 to 36 months.Thirty-two cases (62.68％) were cured,improvement in 19 cases (28.36％) and no effect in 6 cases (8.96％).The total effective rate was 91.04％.There was no severe allergic reaction or pulmonary fibrosis.Secondary operation was performed after 6 months in 12 cases.Two post-operative complications were found,1 was minor paralyses of mandibular branch of facial nerve,with mouth askew,the other was trachyphonia,who were both improved after rehabilitation treatment.Conclusions In order to avoid serious complications,the huge LMs may be given local injection of Pingyangmycin combined with Triamcinolone Acetonide after puncturing fluid with ultrasonography guiding.Graded sclerotherapy provides for a less invasive and shorter course of treatment.The complications and risk of secondary resection increase slightly if sclerotherapy has no curative effect.