Experience in the treatment of lymphatic malformations in children

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Abstract

BACKGROUND: In the treatment of lymphatic malformations, the problem of radical removal and a high risk of recurrence remains.

AIM: Improving the efficiency of treatment of children with lymphatic malformations by introducing new surgical methods and optimizing sclerotherapy.

MATERIAL AND METHODS: The results of treatment of 150 patients with lymphangiomas and an experimental study of the effects of sclerosing drugs on the lining of lymphangioma are presented. The study included 67 (44.7%) girls and 83 (55.3%) boys. The patients were divided into three groups. The first group (72 children) consisted of patients with radical removal of lymphangioma. The second group included 70 patients with partial resection of lymphangioma and sclerosis of residual cavities. The third group (8 children) consisted of patients operated on by video endoscopic method. A histological study of micropreparations of lymphangioma after sclerosis with ethanol and sodium tetradecyl sulfate with an exposure of 5 minutes was carried out. Statistical analysis was carried out using the StatTech v. 2.2.0 using methods of parametric and non-parametric analysis. Results were considered statistically significant at p <0.05.

RESULTS: In the first group of patients, 9 (11.1%) relapses occurred, in the second — 12 (12.3%), in the third group — 0 relapses. Treatment combined with sclerotherapy did not lead to a significant increase in the recurrence rate (p=0.541). Types of lymphatic malformations and their location did not significantly affect the risk of recurrence (p=0.232 and p=0.552, respectively). Sclerosis of the lymphangioma lining with 70% ethanol and a liquid form of sodium tetradecyl sulfate caused total desquamation of the endothelium. Sclerosing with the foam form of sodium tetradecyl sulfate led to total desquamation of the endothelium during a 3-minute exposure.

CONCLUSION: The introduction of minimally invasive methods of treatment and the improvement of sclerosis will make the results of treatment of children with lymphangiomas better.

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About the authors

Maria A. Zykova

Children's Republican Clinical Hospital

Author for correspondence.
Email: sana86.86@mail.ru
ORCID iD: 0000-0002-1237-3547

M.D., Cand. Sci. (Med.), Children's Republican Clinical Hospital

Russian Federation, Kazan, Russia

Ildar N. Nurmeev

Kazan State Medical University

Email: nurmeev@gmail.com
ORCID iD: 0000-0002-1023-1158

M.D., D. Sci. (Med.), Prof., Depart. of Pediatric Surgery

Russian Federation, Kazan, Russia

Leonid M. Mirolubov

Children's Republican Clinical Hospital; Kazan State Medical University

Email: mirolubov@mail.ru
ORCID iD: 0000-0002-2712-8309

M.D., D. Sci. (Med.), Prof., Head of Depart., Depart. of Pediatric Surgery

Russian Federation, Kazan, Russia; Kazan, Russia

Guzel R. Valeeva

Children's Republican Clinical Hospital; Kazan (Volga Region) Federal University

Email: egalisa17@gmail.com
ORCID iD: 0000-0002-1005-0568

M.D., Cand. Sci. (Med.)

Russian Federation, Kazan, Russia; Kazan, Russia

Valery I. Morozov

Children's Republican Clinical Hospital; Kazan State Medical University

Email: morozov.valer@rambler.ru
ORCID iD: 0000-0001-5020-1343

M.D., D. Sci. (Med.), Prof., Depart. of Pediatric Surgery

Russian Federation, Kazan, Russia; Kazan, Russia

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Supplementary files

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2. Fig. 1. Lymphangioma micropreparation. Hematoxylin and eosin staining, ×10. Diffuse intrathecal cavities. Congestive hemorrhage of the microcirculatory vessels

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3. Fig. 2. Result of the exposure of the lymphangioma endothelium to 70% ethanol (ethyl alcohol) for 3 min in the in vitro experiment. Hematoxylin and eosin staining, ×40. In areas of endothelial destruction and verticalization, fragments of the detached endothelium in the lumen of the lymphangioma cavity are determined.

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4. Fig. 3. Result of lymphangioma endothelium exposure to sodium tetradecyl sulfate for 5 min in the in vitro experiment. Hematoxylin and eosin staining, ×20. Complete destruction of endothelial layer and deeper connective tissue structures. Dystrophic processes are accompanied by elements of lysis.

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