摘要
Abstract
Objective To summarize the clinical characteristics,preoperative complications and clinical outcomes of omental lymphatic malformations(OLMs)in children and examine the influencing factors of selec-ting surgical approaches.Methods From January 2010 to December 2022,the relevant clinical data were ret-rospectively reviewed for 76 OLMs children.Follow-ups were conducted until July 2023.Based upon cyst con-tents,they were assigned into subjects with or without preoperative hemorrhage or infection.And their clinical characteristics were compared.Also laparotomy and laparoscopy groups were selected.And the influencing fac-tors of selecting laparotomy or laparoscopy were examined.Results There were 46 boys and 30 girls with an average age of 3.4(2.1,5.5)years.Twenty-three children(23/76,30.3％)received conservative treatments at other hospitals.The median diameter of cysts was 15.0(10.0,20.0)cm and macrocystic type accounted for 89.5％.And 31(31/76,40.8％)developed preoperative hemorrhage or infection of cyst.Those with preopera-tive hemorrhage or infection of cyst had a higher proportion of abdominal distension(16/31 vs.11/45,P=0.015),a higher proportion of elevated inflammatory markers(12/19 vs.7/24,P=0.026)and a lower pro-portion of cyst with a diameter ≤10cm(4/26 vs.17/43,P=0.044).And 43(43/76,56.6％)and 33(33/76,43.4％)underwent open surgery and laparoscopy respectively and the number of laparoscopy spiked markedly yearly(1 from 2010 to 2012,4 from 2013 to 2015,10 from 2016 to 2018 & 18 from 2019 to 2022).Abdominal pain was the most important influencing factor for selecting laparoscopy(OR=3.1;95％CI,1.1-9.0;P=0.032)and it was followed by cyst size(OR=0.9;95％CI,0.8-1.0;P=0.049).Those undergo-ing laparoscopy started ingestion earlier(1.0[1.0,2.0]vs.2.0[2.0,3.0]day,P=0.001)with a shorter hos-pital stay[4.0(3.5,5.0)vs.6.0(4.0,7.0)day,P=0.001].A total of 61 children(61/76,80.3％)(open surgery,n=32 vs laparoscopy,n=29)were followed up with an average period of 5.7(3.8,9.5)year and 5 cases(5/61,8.2％)developed postoperative complications.No significant difference existed in the incidence of postoperative complications between laparoscopy and open surgery(3/29 vs.2/32,P=0.662).Conclu-sions OLMs in children are challenging to diagnose preoperatively and are more prone to complications.Ab-dominal distension,elevated inflammatory markers and massive cyst may hint at hemorrhage or infection of cyst.Laparoscopy is a preferred treatment with excellent outcomes for OLMs in children.关键词
淋巴管畸形/网膜/外科手术/腹腔镜检查/手术后并发症/儿童Key words
Lymphatic Abnormalities/Omentum/Surgical Procedures,Operative/Laparoscopy/Post-operative Complications/Child
