B超引导下微创负压抽吸技术治疗儿童肢体淋巴管畸形的疗效探讨
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摘要
目的探讨B超引导下微创负压抽吸技术治疗儿童肢体淋巴管畸形的临床疗效。方法回顾性分析首都医科大学附属北京儿童医院2015年1月至2017年9月收治的12例肢体淋巴管畸形患儿临床资料,其中男7例,女5例,年龄3～13岁,平均年龄(6. 38±2.85)岁。术前测量患肢肿物最明显处围度及健侧相同处围度。采用B超引导下微创负压抽吸技术进行治疗,术后均留置引流管并佩戴弹力套。术后测量肿物最明显处围度,将术前患侧围度分别与术前健侧围度及术后患侧围度进行对比。结果本组病例切口均一期愈合。术前患侧围度与术前健侧围度比较差异有统计学意义(P<0.05),术后患侧围度与术前患侧围度比较差异有统计学意义(P<0. 05),术后患侧围度与术前健侧围度比较差异无统计学意义(P>0.05)。平均随访(14.27±2.42)个月,12例患儿术后外观明显改善,无明显神经肌肉受损。结论B超引导下微创负压抽吸技术治疗儿童肢体淋巴管畸形整体效果良好。
Objective To research the efficacy of mini-invasive negative pressure aspiration under the guidance of B-ultrasound in the treatment of limb lymphatic malformations in children.Methods Twelve cases of limb lymphatic malformations between January 2015 and September 2017 were reviewed. There were 7 boys and 5 girls with an average age of(6.38 ±2. 85)(3-11) years. The longest circumferences of affected limb as compared to healthy side were measured before operation. Operation was performed with mini-invasive negative pressure aspiration under the guidance of B-ultrasound. Drainage catheter and elastic suit were retained. Multiple comparisons were made among three groups. Results All wounds healed primarily. Statistically significant difference existed between preoperative circumferences at both sides(P <0. 05). And there was statistically significant difference in side circumference between affected side and preoperative side circumference(P <0.05). No significant difference existed in side circumference between affected side and preoperative healthy side circumference(P > 0. 05). The postoperative follow-up period was(14. 27 ± 2. 42) months. Overall appearances significantly improved. There was no injury of muscle, blood vessel or nerve. There was no recurrence. Conclusion B-ultrasonography guided mini-invasive negative pressure aspiration is effective and miniinvasive for limb lymphatic malformations in children.
Objective To research the efficacy of mini-invasive negative pressure aspiration under the guidance of B-ultrasound in the treatment of limb lymphatic malformations in children.Methods Twelve cases of limb lymphatic malformations between January 2015 and September 2017 were reviewed. There were 7 boys and 5 girls with an average age of(6.38 ±2. 85)(3-11) years. The longest circumferences of affected limb as compared to healthy side were measured before operation. Operation was performed with mini-invasive negative pressure aspiration under the guidance of B-ultrasound. Drainage catheter and elastic suit were retained. Multiple comparisons were made among three groups. Results All wounds healed primarily. Statistically significant difference existed between preoperative circumferences at both sides(P <0. 05). And there was statistically significant difference in side circumference between affected side and preoperative side circumference(P <0.05). No significant difference existed in side circumference between affected side and preoperative healthy side circumference(P > 0. 05). The postoperative follow-up period was(14. 27 ± 2. 42) months. Overall appearances significantly improved. There was no injury of muscle, blood vessel or nerve. There was no recurrence. Conclusion B-ultrasonography guided mini-invasive negative pressure aspiration is effective and miniinvasive for limb lymphatic malformations in children.
引文
1 Dasgupta R, Fishman SJ. ISSVA classification[J]. Semin Pediatr Surg, 2014, 23(4):158-161. DOI. org/10. 1053/j.sempedsurg. 2014. 06. 016.
2段于河,支运来,吴翮.沙培林在淋巴管瘤切除术后复发患者中的应用分析[J].临床小儿外科杂志,2015, 14(5):441-442. DOI:10. 3969/j. issn. 1671-6353. 2015.05.028.Duan YH,Zhi YL, Wu H. Application of sapylin in recurrent patients after lymphangioma resection[J]. J Clin Ped Sur,2015,14(5):441-442. DOI:10. 3969/j. issn. 1671-6353.2015.05.028.
3李杰荣,刘国度,唐华建.B超引导下注射平阳霉素治疗婴幼儿囊性淋巴管瘤22例[J].临床小儿外科杂志,2007,6(4):37-38.DOI:10. 3969/j. issn. 1671-6353.2007.04.013.Li JR,Liu GD,Tang HJ. B-ultrasound-guided injection of bleomycin A5 in the treatment of 22 cases of infantile cystic lymphangioma[J]. J Clin Ped Sur, 2007,6(4):37-38.DOI:10. 3969/j. issn. 1671-6353.2007.04. 013.
4 J Goswamy,SE Penney,IA Bruce. Radiofrequency ablation in the treatment of paediatric microcystic lymphatic malformations[J]. Laryngol Otol,2013, 127(3):279-284. DOI:10.1007/s0022215113000029.
5 Defnet AM,Bagrodia N, Hernandez SL,et al. Pediatric lymphatic malformations:evolving understanding and therapeutic options[J]. Pediatr Surg Int,2016,32(5):425-433. DOI:10.1007/s00383-016-3867-4.
6黄贞,朱晓峰,周松.自体颗粒脂肪移植在面部轮廓整形中的方法分析[J].中国医疗美容,2017,7(9):12-14.DOI:10.19593/j. issn. 2095-0721. 2017, 09.006.Huang Z,Zhu XF,Zhou S. Analysis of autologous fat transplantation during facial contour plasty[J]. China Medical Cosmetology,2017,7(9):12-14. DOI:10. 19593/j. issn.2095-0721.2017.09.006.
7韩涛,邹继军,陈海妮,等.单一中心婴幼儿淋巴管畸形治疗的效果分析[J].中华整形外科杂志,2017,33(2):84-87. DOI:10. 3760/cma.j. issn. 1009-4598.2017.02.002.Han T,Zou JJ, Chen HN, et al. Efficacy of single-center infants with lymphatic malformation[J]. Chinese Plastic Surgery,2017,33(2):84-87. DOI:10.3760/cma. j. issn. 1009-4598.2017.02.002.
8中华医学会整形外科分会血管瘤和脉管畸形学组.血管瘤和脉管畸形诊断和治疗指南(2016版)[J].组织工程与重建外科杂志,2016, 12(2):76-77. DOI:10. 3969/j.issn. 1673-0364. 2016. 02. 001.Chinese Medical Association Plastic Surgery Branch of Hemangioma&Vascular Malformation Group Guidelines on the Diagnosis and Treatment of Hemangioma and Vascular Malformation(2016 edition)[J]. Journal of Tissue Engineering&Reconstructive Surgery,2016, 12(2):76-77. DOI:10.3969/j. issn. 1673-0364. 2016. 02. 001.
9刘文英.淋巴管畸形的诊疗进展[J].中华妇幼临床医学杂志,2012, 8(6):573-575. DOI:10. 3877/cma. j. issn.1673-5250.2012.06.001.Liu WY. Progress in the diagnosis and treatment of lymphatic abnormalities[J]. Chinese Journal of Obstetrics&Gynecology and Pediatrics, 2012, 8(6):573-575. DOI:10. 3877/cma. j. issn. 1673-5250.2012.06.001.
10张浩川,李仲荣,陈肖明.小儿颈部淋巴管瘤手术并发症防治对策(附31例临床分析)[J].临床小儿外科杂志,2004,3(5):378-380. DOI:10. 3969/j. issn. 1671-6353.2004.05.017.Zhang HC,Li ZR,Chen XM. Prevention and treatment of complications of cervical lymphangioma in children:clinical analysis of 31 cases[J].J Clin Ped Sur,2007,6(4):378-380. DOI:10.3969/j. issn. 1671-63 53.2004.05.017.
11韩洪军.负压吸脂术临床应用效果评价[J].中国医疗美容,2015,23(5):24-26. DOI:10. 19593/j.issn. 2095-0721.2015.05.013.Han HJ. Evaluation of the clinical effect of negative pressure liposuction[J]. China Medical Cosmetology, 2015, 23(5):24-26. DOI:10. 19593/j. issn. 2095-0721. 2015.05.013.
12 Bagrodia N,Defnet AM,Kandel JJ. Management of lymphatic malformations in children[J]. Curr Opin Pediatr,2015,27(3):356-363. DOI:10.1097/MOP. 0000000000000209.
13蒋艳玲,黄文雅,罗勇奇.儿童淋巴管畸形44例诊疗分析[J].临床小儿外科杂志,2014,13(5):450-455. DOI:10. 3969/j. issn. 1671-6353. 2014. 05. 024.Jiang YL, Huang WY, Luo YQ. Diagnosis and treatment of lymphatic malformations in children:a report of 44 cases[J]. J Clin Ped Sur,2014, 13(5):450-455. DOI:10.3969/j. issn. 1671-6353.2014.05.024.
14高国燕.吸脂术并发症的预防及治疗[J].医学信息,2013,26(7):348. DOI:10. 3969/j. issn. 1006-1959.2013. 13.440.Gao GY. Prevention and treatment of complications of liposuction[J]. Medical Information, 2013, 26(7):348. DOI:10. 3969/j. issn. 1006-1959.2013. 13.440
2段于河,支运来,吴翮.沙培林在淋巴管瘤切除术后复发患者中的应用分析[J].临床小儿外科杂志,2015, 14(5):441-442. DOI:10. 3969/j. issn. 1671-6353. 2015.05.028.Duan YH,Zhi YL, Wu H. Application of sapylin in recurrent patients after lymphangioma resection[J]. J Clin Ped Sur,2015,14(5):441-442. DOI:10. 3969/j. issn. 1671-6353.2015.05.028.
3李杰荣,刘国度,唐华建.B超引导下注射平阳霉素治疗婴幼儿囊性淋巴管瘤22例[J].临床小儿外科杂志,2007,6(4):37-38.DOI:10. 3969/j. issn. 1671-6353.2007.04.013.Li JR,Liu GD,Tang HJ. B-ultrasound-guided injection of bleomycin A5 in the treatment of 22 cases of infantile cystic lymphangioma[J]. J Clin Ped Sur, 2007,6(4):37-38.DOI:10. 3969/j. issn. 1671-6353.2007.04. 013.
4 J Goswamy,SE Penney,IA Bruce. Radiofrequency ablation in the treatment of paediatric microcystic lymphatic malformations[J]. Laryngol Otol,2013, 127(3):279-284. DOI:10.1007/s0022215113000029.
5 Defnet AM,Bagrodia N, Hernandez SL,et al. Pediatric lymphatic malformations:evolving understanding and therapeutic options[J]. Pediatr Surg Int,2016,32(5):425-433. DOI:10.1007/s00383-016-3867-4.
6黄贞,朱晓峰,周松.自体颗粒脂肪移植在面部轮廓整形中的方法分析[J].中国医疗美容,2017,7(9):12-14.DOI:10.19593/j. issn. 2095-0721. 2017, 09.006.Huang Z,Zhu XF,Zhou S. Analysis of autologous fat transplantation during facial contour plasty[J]. China Medical Cosmetology,2017,7(9):12-14. DOI:10. 19593/j. issn.2095-0721.2017.09.006.
7韩涛,邹继军,陈海妮,等.单一中心婴幼儿淋巴管畸形治疗的效果分析[J].中华整形外科杂志,2017,33(2):84-87. DOI:10. 3760/cma.j. issn. 1009-4598.2017.02.002.Han T,Zou JJ, Chen HN, et al. Efficacy of single-center infants with lymphatic malformation[J]. Chinese Plastic Surgery,2017,33(2):84-87. DOI:10.3760/cma. j. issn. 1009-4598.2017.02.002.
8中华医学会整形外科分会血管瘤和脉管畸形学组.血管瘤和脉管畸形诊断和治疗指南(2016版)[J].组织工程与重建外科杂志,2016, 12(2):76-77. DOI:10. 3969/j.issn. 1673-0364. 2016. 02. 001.Chinese Medical Association Plastic Surgery Branch of Hemangioma&Vascular Malformation Group Guidelines on the Diagnosis and Treatment of Hemangioma and Vascular Malformation(2016 edition)[J]. Journal of Tissue Engineering&Reconstructive Surgery,2016, 12(2):76-77. DOI:10.3969/j. issn. 1673-0364. 2016. 02. 001.
9刘文英.淋巴管畸形的诊疗进展[J].中华妇幼临床医学杂志,2012, 8(6):573-575. DOI:10. 3877/cma. j. issn.1673-5250.2012.06.001.Liu WY. Progress in the diagnosis and treatment of lymphatic abnormalities[J]. Chinese Journal of Obstetrics&Gynecology and Pediatrics, 2012, 8(6):573-575. DOI:10. 3877/cma. j. issn. 1673-5250.2012.06.001.
10张浩川,李仲荣,陈肖明.小儿颈部淋巴管瘤手术并发症防治对策(附31例临床分析)[J].临床小儿外科杂志,2004,3(5):378-380. DOI:10. 3969/j. issn. 1671-6353.2004.05.017.Zhang HC,Li ZR,Chen XM. Prevention and treatment of complications of cervical lymphangioma in children:clinical analysis of 31 cases[J].J Clin Ped Sur,2007,6(4):378-380. DOI:10.3969/j. issn. 1671-63 53.2004.05.017.
11韩洪军.负压吸脂术临床应用效果评价[J].中国医疗美容,2015,23(5):24-26. DOI:10. 19593/j.issn. 2095-0721.2015.05.013.Han HJ. Evaluation of the clinical effect of negative pressure liposuction[J]. China Medical Cosmetology, 2015, 23(5):24-26. DOI:10. 19593/j. issn. 2095-0721. 2015.05.013.
12 Bagrodia N,Defnet AM,Kandel JJ. Management of lymphatic malformations in children[J]. Curr Opin Pediatr,2015,27(3):356-363. DOI:10.1097/MOP. 0000000000000209.
13蒋艳玲,黄文雅,罗勇奇.儿童淋巴管畸形44例诊疗分析[J].临床小儿外科杂志,2014,13(5):450-455. DOI:10. 3969/j. issn. 1671-6353. 2014. 05. 024.Jiang YL, Huang WY, Luo YQ. Diagnosis and treatment of lymphatic malformations in children:a report of 44 cases[J]. J Clin Ped Sur,2014, 13(5):450-455. DOI:10.3969/j. issn. 1671-6353.2014.05.024.
14高国燕.吸脂术并发症的预防及治疗[J].医学信息,2013,26(7):348. DOI:10. 3969/j. issn. 1006-1959.2013. 13.440.Gao GY. Prevention and treatment of complications of liposuction[J]. Medical Information, 2013, 26(7):348. DOI:10. 3969/j. issn. 1006-1959.2013. 13.440