背景:很少有研究分析肠系膜淋巴管畸形(ML)的囊肿特征和并发症。本研究旨在比较不同位置ML的囊肿特征和术前并发症,并建议对需要手术的患者进行改良的ML分类。
方法:总共,2010年1月至2021年12月,157例ML患者在北京儿童医院接受了手术治疗。总结囊肿特点及术前并发症。根据改良的ML分类(I型,n=87,累及肠壁;II型,n=45,位于肠系膜边界;III型,n=16,涉及肠系膜的根部;IV型,n=7,多中心ML;类型V,n=2,累及上直肠)。
结果:总体而言,111(70.7%)ML位于肠系膜,44(28.0%)位于肠系膜。I型和II型ML主要累及肠系膜(64.9%)和结肠系膜(56.8%),分别(P<0.001)。微囊型ML和乳糜液ML仅位于肠系膜。仅在肠系膜ML患者中发现肠扭转(P<0.001),而结肠系膜的ML更容易出血(P=0.002)和感染(P=0.005)。空肠肠系膜ML是肠扭转的独立危险因素(OR=3.5,95%CI1.5~8.3,P=0.003)。I型和II型ML之间的手术方法显着不同(P<0.001)。
结论:不同位置的ML具有不同的特征。对于需要手术的患者,新的ML分类可用于选择合适的手术方法.
方法:三级。
BACKGROUND: Few studies have analyzed the cyst characteristics and complications of mesenteric lymphatic malformations (ML). This
study aimed to compare ML\'s cyst characteristics and preoperative complications at different locations and suggest a modified ML classification for patients requiring surgery.
METHODS: In total, 157 ML patients underwent surgery at Beijing Children\'s Hospital between January 2010 and December 2021. The cyst characteristics and preoperative complications were reviewed. The surgical methods for ML were analyzed according to the modified ML classification (Type I, n = 87, involving the intestinal wall; Type II, n = 45, located in the mesenteric boundaries; Type III, n = 16, involving the root of the mesentery; Type IV, n = 7, multicentric ML; Type V, n = 2, involving the upper rectum).
RESULTS: Overall, 111 (70.7%) ML were located at the intestinal mesentery and 44 (28.0%) at the mesocolon. Type I and type II ML mainly involved intestinal mesentery (64.9%) and mesocolon (56.8%), respectively (P < 0.001). Microcystic-type ML and ML with chylous fluid were only located in the intestinal mesentery. Intestinal volvulus was only found in patients with ML in the intestinal mesentery (P < 0.001), whereas ML in the mesocolon were more prone to hemorrhage (P = 0.002) and infection (P = 0.005). ML in the jejunal mesentery was an independent risk factor for intestinal volvulus (OR = 3.5, 95% CI 1.5-8.3, P = 0.003). The surgical methods significantly differed between Type I and type II ML (P < 0.001).
CONCLUSIONS: ML at different locations have different characteristics. For patients requiring surgery, the new ML classification can be used to select an appropriate surgical method.
METHODS: Level III.