The interventional treatment of complex lymphatic malformation in children

Abstract

Objective To explore the interventional treatment method for complex and refractory lymphatic malformation in children. Methods The clinical data of 78 cases with complex and refractory lymphatic malformation during January 2013 to January 2016 in our department were retrospectively analyzed. The lesions involved the neck in 28 cases, maxillofacial regions in 19 cases, the chest and armpit in 8 cases, the limb in 7 cases, the pelvic cavity and retroperitoneal space in 6 cases, the superior mediastinum in 3 cases, the hypogloeeis in 3 cases and scrotum or perineum region in 4 cases. All the children underwent ultrasound or MRI imaging studies preoperatively. The interventional procedures included: (1) Percutaneous puncture of the LM for sclerotherapy. The lesions were punctured with 20 G needle under the guidance of DSA or ultrasound and the correct positions were confirmed with angiography. The liquid of the lesions was extracted as far as possible. The dosage of sclerosing agents was adjusted according to the size of lesion. The dose of Laurolacrogol injection was 1/10—1/5 of the amount of the liquid in the lesions and the maximum of Laurolacrogol foam was ≤8 ml (20 mg) . The dose of Pingyangmycin was ≤8 mg. (2) The drainage catheter placement and sclerotherapy. Percutaneous catheter drainage under ultrasound guidance or by surgery was conducted. The liquid in the lesions was drained by retaining the catheter for 1—4 weeks, and sclerotherapy was applied for several sessions during this period. (3) Treatment for one time a week, 2 times a session. The interval of every two sessions was 4 weeks. The sclerosing agents included: Laurolacrogol Injection or Pingyangmycin for the lesions with high tension, Laurolacrogol foam for the lesions with low tension, Pingyangmycin for the microcystic lesions. Statistical analysis was conducted using SPSS20.0 software. Results A total of 208 sessions of sclerotherapy for 78 LM patients were performed and average session was (3.0±0.8) . Nine patients used Lauromacrogol foam, 23 patients used Lauromacrogol Injection, 39 patients used pingyangmycin, while combined treatment was conducted in 7 patients. Laurolacrogol injection was used in 20 cases, Pingyangmycin in 29 cases and combination therapy in 5 cases for the high tension lesions in the neck, maxillofacial, chest and armpit. The low tension lesions of pelvic cavity and retroperitoneal space in 6 cases and of superior mediastinum in 3 cases were placed with draining catheters, and treated with sclerotherapy with Laurolacrogol foam. Three cases with hypogloeeis LM was neonates, who were treated with Laurolacrogol injection. The lesions on the limb and scrotum or perineum region were almost microcystic, were treated with Pingyangmycin in 9 cases and with combination therapy in 2 cases. The total curative rate was 97.4% (76/78), total effective rate was 100% (78/78). Imaging examinations showed that the cavities were closed or only a small amount of residual sclerotic lesions were present. Clinical examinations showed that the surface masses almost disappeared. The follow up period was 6 months to 2 years. There were no serious complication and adverse reactions occurred. Conclusions Interventional treatment is a safe, effective, and minimally invasive treatment for the complex and refractory lymphatic malformation. In order to receive the best treatment effect, we should use targeted therapy for different region and type of LM. Key words: Lymphatic abnormalities; Radiology, interventional; Sclerotherapy