摘要
根据ISSVA、Waner和Suen的分类,过去所称的淋巴管瘤现统称为淋巴管畸形,包括微囊型和大囊型2类,以头颈部最多见。其发病原因不清,治疗方法多样。本文复习新近文献,论述了淋巴管畸形的手术治疗、硬化治疗、激光治疗的适应证、优缺点等,并介绍了其分子生物学研究和治疗前景。认为淋巴管畸形虽属良性病损,但极少自然消退,常与头颈部重要结构毗邻且具有局部浸润性而引起严重并发症和高复发率,给临床治疗带来了很大困难。虽然目前可用的治疗方法很多,但均有优点与不足,应根据患者病情和技术条件,制定个体化治疗方案,采用综合治疗,以期获得最佳疗效。对黏膜表面的微囊型淋巴管畸形、面颈部大囊型淋巴管畸形,平阳霉素、OK-432等病变内注射可获得良好的效果。黏膜表面的微囊型淋巴管畸形,也适于激光治疗。组织深部的微囊型淋巴管畸形的治疗,仍然是临床上面临的难题。目前不主张毫无指征地对任何类型的淋巴管畸形进行手术切除,手术适用于局限的、黏膜表面的微囊型淋巴管畸形和面颈部大囊型淋巴管畸形的治疗。手术中应注意重要结构的辨别和保护。对于复杂病例,提倡采用综合序列治疗。
According to the classification of ISSVA, Waner and Suen, the traditionally called lymphangiomas are now referred to as lymphatic malformations, including both macrocystic and microcystic lesions. They are commonly seen vascular anomalies, and most frequently diagnosed at birth and most often occur in the head and neck area. The etiology of lymphatic malformations is still unknown, resulting in a variety of treatment modalities. This paper reviewed the recent literatures with respect to the indications, contraindications, advantages and disadvantages of surgical excision, sclerotherapy and laser ablation of lymphatic malformations of the head and neck, with detailed discussion of the advances in molecular biology and clinical treatment prospects. It is concluded that although lymphatic malformations are benign lesions, they seldom involute spontaneously. Of all vascular malformations, lymphatic malformations are the most difficult to be eradicated. Their infiltrating nature coupled with the difficulty in distinguishing involved important structures of the head and neck from adjacent normal tissues makes complete surgical extirpation even more difficult. The likelihood of postsurgical recurrence and complications is thus higher than other vascular lesions. Although many treatment protocols are available in clinic, indications, contraindications, advantages and disadvantages exist in each modality. The selection of treatment modalities should depend on the patients＇ status and techniques available. The treatment protocol should be individualized and comprehensive as well as sequential, in order to obtain the best treatment outcomes. In general, treatment will vary according to the depth and the extent of the lesions. Superficial mucosal microcystic lesions and cervicofacial macrocystic lesions are amenable to ablation with sclerotherapy using Bleomycin and OK-432 with the advantages of the absence of a surgical scar. The sclerosing agent OK-432 is effective for macrocystic lymphatic malformations but showed less promise for microcystic lesions, mixed lesions, and lesions outside the head and neck region. In addition, superficial mucosal microcystic lesions are also amenable to CO2 laser therapy. Deeper microcystic lesions are still challenging head and neck surgeons, which are usually extensive and sometimes need to be resected in stages, and even may be impossible to be completely removed. Somnoplasty shows promise for reduction of tongue lymphatic malformations. Surgical excision, staged when necessary, continues to be integral to management in many cases, but should not be overused without consideration of the histologic types and extent. Localized mucosal microcystic lesions and major cervicofacial macrocystic lesions are amenable to primary excision. Care should be exercised in identifying and preserving important cervical and facial structures because anatomical planes are often distorted. Combined sequential approach is recommended for mixed lesions as well as extensive lesions involving both the mucosa and soft tissues.
出处
《上海口腔医学》
CAS
CSCD
2005年第6期553-556,共4页
Shanghai Journal of Stomatology
作者简介
郑家伟（1964-），医学博士，教授，硕士研究生导师．主要从事血管瘤与脉管畸形的基础与临床研究
[通讯作者]张志愿，Tel：021-63138341-5385，Fax：021-63136856．E-mail：zhzhy@omschina．org．cn
