摘要
目的探讨镇静下B型超声引导下低浓度平阳霉素注射微创治疗软组织淋巴管瘤的安全性及有效性。方法1110例软组织淋巴管瘤患儿，年龄1个月～17岁8个月。病变类型：大囊型淋巴管瘤（囊状水瘤）233例、小囊型淋巴管瘤391例、海绵状淋巴管瘤247例、混合型淋巴管瘤224例、弥漫性淋巴管瘤15例。基础麻醉下行B型超声引导下低浓度平阳霉素注射微创治疗，大囊及小囊性淋巴管瘤浓度为0．4mg／ml囊内注入，海绵状、混合性及弥漫性淋巴管瘤为0．33mg／ml浓度瘤内多点注入。单次治疗最大剂量：学龄儿及以上（≥5岁）不超过4mg；3～5岁不超过2～3nag，幼儿（〈3岁）不超过2mg；婴儿（〈1岁）不超过1mg；年龄小于6月龄的婴儿用量〈0．5mg，1月龄内不采用平阳霉素治疗，1～2月龄慎用。每隔2～3个月一次，共1～10余次不等。结果1110例软组织淋巴管瘤患儿总的完全缓解率为51．62％，非常好的部分缓解率为41．53％，部分缓解率为4．59％，微缓解率为1．17％，疾病稳定率为1．08％。其中淋巴管瘤各类型中大囊型疗效最好，CR为100％；其次为小囊型，CR为86．96％；CR仅发生在大囊型及小囊型两组。海绵状VGPR83．40％；混合性VGPR91．07％；弥漫型疗效最差，80％为SD，20％为MR。迟发瘤内出血及迟发感染等并发症发生率为3．42％，无急性感染、皮肤破溃、坏死、硬变、肺纤维化等严重并发症。结论镇静下B超引导下低浓度平阳霉素注射精准微创治疗软组织淋巴管瘤为安全、有效的治疗方法。
Objective To explore the safety and efficacy of treating lymphangioma with an intralesional injection of low-concentration pingyangmycin by ultrasonic guidance under sedation. Methods A total of 1110 cases with soft tissue lymphangioma aged from 1-212 months received an intralesional mini-invasive injection of low-concentration pingyangnaycin by ultrasonic guidance. The clinical pathological types were large cystic lymphangioma （cystic hygroma, n= 233）, utricle lymphangioma （n = 391 ）, cavernous lymphangioma （n = 247）, mixed lymphangioma （n = 224） and diffuse lyrnphangiorna （n = 15）. Under basal anesthesia, the concentration of pingyangmycin for large cystic lymphangioma and utricle lymphangioma was 0. 4 mg/ml via cyst cavity injection and 0. 33 mg/ml for other types via multi-point injection into tumor. The maximal dose of single therapy： 〈4 mg for school-age children （≥5 years） ; 〈2-3 nag for children aged 3-5 years; 〈2 mg for kids （〈3 years） ; %1 mg for infants （〈1 year） and d0. 5 mg for infants aged 〈6 months. Pingyangrnycin was never used in children aged %1 month and applied cautiously in children aged 1-2 months. They received single injection every 2-3 months for 1-10 cycles. Results Among 1110 cases of soft tissue lymphangioma, the clinical responses were complete remission （51.62%）, excellent partial remission （41.53%）, partial remission （4. 59%）, micro-remission （1.17%） and stable disease （1.08%）.Among them, the curative effect of large cystic lymphangioma was the best and 100% children achieved CR; the next was utricle lymphangioma and 86. 96% children achieved CR. Only children with large cystic lymphangioma or utricle lymphangioma achieved CR. VGPR for cavernous lymphangioma was 83.40% and 91.07% for mixed lymphangioma. The curative effect of diffuse lymphangioma was the worst and 80% children achieved SD and 20% MR. The incidence rate of such delayed complications as bleeding within tumor and infection was 3. 42%. There was no such severe complication as acute infection, skin burst, necrosis, cirrhosis or pulmonary fibrosis. Conclusions By ultrasonic guidance under sedation, intralesional precise and mini-invasive injection of low- concentration pingyangmycin is both safe and efficacious for lymphangioma.
作者
王珊
赖子梅
姚祥
张璐
Wang Shan Lai Zimei Yao Xiang Zhang Lu(Department of Oncological Surgery, Children＇s Hospital, Chongqing Medical University, Ministry of Education Key Laboratory of Child Development ＆ Disorders, Chongqing International Science Technology Cooperation Center for Child Development ＆ Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing, 400014, China)
出处
《中华小儿外科杂志》
CSCD
2017年第1期32-37,共6页
Chinese Journal of Pediatric Surgery
基金
国家临床重点专科建设项目[国卫办医函（2013）554号]
关键词
淋巴管瘤
平阳霉素
镇静
Lymphangioma
Pingyangmycin
Sedation
