Детская хирургия. Журнал им. Ю.Ф. Исакова. 2022; 26: 150-155
Лапароскопические вмешательства у детей с ретроперитониальными лимфатическими мальформациями
https://doi.org/10.55308/1560-9510-2022-26-3-150-155Аннотация
Введение. Лимфатические мальформации (ЛМ) – порок развития лимфатических сосудов, формирующийся в раннем эмбриогенезе. Интраабдоминальные и забрюшинные ЛМ очень редки и составляют от 4 % всех наблюдений.
Цель исследования – уточнить эффективность мини-инвазивных хирургических вмешательств у детей с абдоминальными ЛМ.
Материал и методы. За десятилетний период в клиниках нашей кафедры были прооперированы 15 детей с ретроперитониальными лимфангиомами в возрасте от 1 года до 17 лет. Для уточнения диагноза применяли комплексное обследование брюшной полости – ультразвуковое исследование, спиральную компьютерную томографию, магнитно-резонансную томографию. Во всех 15 случаях оперативные вмешательства были выполнены лапароскопическим доступом.
Результаты. Во всех случаях лимфатические мальформации были диагностированы до операции, что в дальнейшем подтвердилось при лапароскопии. Мальформации были иссечены лапароскопически во всех 15 случаях. У 2 пациентов была оставлена часть лимфангиоматозной ткани в месте наибольшего сращения с почечными и подвздошными сосудами в связи с высоким риском их повреждения.
Заключение. Применение эндовидеохирургических технологий у детей с ретроперитониальными ЛМ возможно у детей любого возраста при любых размерах забрюшинных кистозных образований, так как опорожнение кистозной полости создает необходимое рабочее пространство в брюшной полости. Подобный подход минимизирует операционную травму, сокращает время операции, облегчает течение послеоперационного периода.
Список литературы
1. Leonidas J. C., Brill P. W., Bhan I., et al. Cystic retroperitoneal lymphangioma in infants and children. Radiology. 1978; 127: 203–8.
2. Iyer R., Eftekhari F., Varma D., et al. Cystic retroperitoneal lymphangioma: CT, ultrasound and MR findings. Pediatr Radiol. 1993; 23: 305–6.
3. Irvine A. D., Sweeney L., Corbett J. R. Lymphangioma circumscriptum associated with paravesical cystic retroperitoneal lymphangioma. Br J Dermatol. 1996; 134: 1135–7.
4. Waldhausen J. H., Holterman M. J., Tapper D. Identification and surgical management of cystic retroperitoneal lymphangioma in children. Pediatr Surg Int. 1996; 11: 283–5.
5. Meyer T., Stöhr G., Post S., et al. Retroperitoneal lymphangioma presenting as a mesenteric cyst. Eur J Radiol. 1995; 21: 143–4.
6. Соколов Ю. Ю. Хирургические вмешательства у детей с внутрибрюшными лимфангиомами / Ю. Ю. Соколов [и др.] // Российский вестник детской хирургии, анестезиологии, реаниматологии. – 2014. – (1): 20–4. – Sokolov Yu. Yu., Donskoy D. V., Vilesov A. V. et al. Surgical interventions in children with intra-abdominal lymphangiomas. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2014; (1): 20–4. (in Russian)
7. Freud E., Farkash U., Cassella R., et al. Childhood retroperitoneal lymphangioma presenting following minor trauma. Injury. 1999; 30: 380–3.
8. Ольхова Е. Б. Ультразвуковая диагностика мезентериальных лимфангиом у детей / Е. Б. Ольхова [и др.] // Радиологическая практика. – 2017. – 65 (5): 6–20. – Olkhova E. B., Mukaseeva T. V., Sokolov Yu. Yu., Bibikova E. E. Ultrasonic diagnosis of mesenteric lymphangiomas in children. Radiologicheskaya praktika. 2017; 65 (5): 6–20. (in Russian)
9. Khetarpal R., Halwai G., Marwaha R. K., et al. Retro-peritoneal cystic lymphangioma in association with fetal hydantoin syndrome. Indian J Pediatr. 1999; 66: 294–7.
10. Shankar K. R., Roche C. J., Carty H. M., et al. Cystic retroperitoneal lymphangioma: treatment by image-guided percutaneous catheter drainage and sclerotherapy. Eur Radiol. 2001; 11: 1021–3.
11. Шароев Т. А. Лимфангиомы брыжейки тонкой кишки у детей (обзор литературы и собственные клинические наблюдения) / Т. А. Шароев [и др.] // Российский вестник детской хирургии, анестезиологии и реаниматологии. – 2012. – (2): 58–63. – Sharoev T. A., Burkov I. V., Kovalev D. V. et al. Lymphangiomas of the mesentery of the small intestine in children (literature review and own clinical observations). Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2012; (2): 58–63. (in Russian)
12. Литовка В. К. Обширная кистозная лимфгемангиома забрюшинного пространства малого таза с распространением в паховые каналы и мошонку / В. К. Литовка [и др.] // Здоровье ребёнка. – 2012. – 7 (42): 127–9. УДК 616.381-006.2/.314.03-033.5:616.756.26+616.672]-053.2.-089 – Litovka V. K., Zhurilo I. P., Vesely S. V., Latyshov K. V. Extensive cystic lymphhemangioma of the retroperitoneal space of the small pelvis with spread to the inguinal canals and scrotum. Zdorov'e rebyonka. 2012; 7 (42): 127–9. UDC 616.381-006.2/.314.03-033.5:616.756.26+616.672]-053.2.-089 (in Russian)
13. P. de Lagausie A., Bonnard D., Berrebi O., Lepretre L., Statopoulos A., Delarue J.-M. Guys. Abdominal lymphangiomas in children: interest of the laparoscopic аpproach. Surg Endosc. 2007; 21: 1153–7. https://doi.org/10.1007/s00464-006-9091-x
14. So Hyun Nam, Dae Yeon Kim, Seong Chul Kim, In Koo Kim. The surgical experience for retroperitoneal, mesenteric and omental cyst in children. J Korean Surg Soc. 2012; 83: 102–6. https://doi.org/10.4174/jkss.2012.83.2.102
15. Rani D. V., Srilakshmi R., Malathi S., et al. Unusual presentation of a retroperitoneal lymphangioma. Indian J. Pediatr. 2006; 73: 617–8.
16. Wildhaber B. E., Chardot C., Coultre C. L., et al. Total laparoscopic excision of retroperitoneal cystic lymphangioma. J Laparoendosc Adv Surg Tech. 2006; 16: 530–3.
17. Wilson S. R., Bohrer S., Losada R., et al. Retroperitoneal lymphangioma: an unusual location and presentation. J Pediatr Surg. 2006; 41: 603–5.
18. Pratap A., Tiwari A., Sah B. P., et al. Infected retroperitoneal cystic lymphangioma masquerading as psoas abscess. Urol Int. 2008; 80 (3): 325–7. discussion 328. https://doi.org/10.1159/000127351
19. Poroes Fabio, Petermann David, Andrejevic-Blant Snezana, Labgaa Ismail, Di Mare Luca. Pediatric cystic lymphangioma of the retroperitoneum. A case report and review of the literature. Medicine. July 10, 2020; 99 (28): e20827. https://doi.org/10.1097/MD.0000000000020827
20. Olivieri С., Nanni L., De Gaetano A.M., Manganaro L. Complete Resolution of Retroperitoneal Lymphangioma with a Single Trial of OK-432 in an Infant. Pediatrics and Neonatology. 2016; (57): 240–3. https://doi.org/10.1016/j.pedneo.2013.06.011
21. Singh R. R., Govindarajan K. K., Bowen C., et al. Retroperitoneal cystic lymphangioma: a rare presentation in childhood, treated laparoscopically. J Laparoendosc Adv Surg Tech A. 2009; 19: 249–50.
22. Gümüştaş O. G., Sanal M., Güner O., et al. Retroperitoneal cystic lymphangioma: a diagnostic and surgical challenge. Case Rep Pediatr. 2013; 2013: 1–3.
23. Barbara Е. Wildhaber, Сhristophe Сhardot, Claude le Сoultre, Вernard Genin. Total laparoscopic excision of retroperitoneal сystic lymphangioma. Journal of laparoendoscopic & advanced surgical techniques. 2006; 16 (5): 530–3
24. Amodeo I., Cavallaro G., Raffaeli G., Colombo L., Fumagalli M. Abdominal cystic lymphangioma in a term newborn. A case report and update of new treatments. Medicine. 2017; 96 (8): e5984. https://doi.org/10.1097/MD.0000000000005984
25. Brian K. P., Yu-Meng Tan, Hock-Soo Ong. Intra-abdominal and retroperitoneal lymphangiomas in pediatric and adult patients. World J. Surg. 2005; 29: 837–40. https://doi.org/10.1007/s00268-005-7794-0
Russian Journal of Pediatric Surgery. 2022; 26: 150-155
Laparoscopic interventions in children with retroperitonial lymphatic malformations
https://doi.org/10.55308/1560-9510-2022-26-3-150-155Abstract
Introduction. Lymphatic malformations (LM) is the developmental anomaly of lymphatic vessels which is formed at the stage of early embryogenesis. Intraabdominal and retroperitoneal LM are very rare and account for 4 % of all observed LM.
Purpose. To clarify the effectiveness of minimally invasive surgical interventions in children with abdominal LM.
Material and methods. Over a ten-year period, 15 children with retroperitoneal lymphangiomas , aged from 1 to 17, were operated on in our clinics. To clarify diagnosis, a comprehensive examination was performed: ultrasound, spiral computed tomography, magnetic resonance imaging of the abdominal cavity. Laparoscopic access was applied in all 15 cases for surgical intervention.
Results. In all cases, lymphatic malformations were diagnosed before surgery which was later confirmed at laparoscopy. Malformations were excised laparoscopically. In 2 patients, lymphangiomatous tissue was partially left at the site of the greatest fusion with renal and iliac vessels due to a high risk of their damage.
Conclusion. Endovideosurgical technologies in children with retroperitoneal LM may be used at any child’s age and at any size of retroperitoneal cystic formation since emptying the cystic cavity creates the necessary working space in the abdominal cavity. Such an approach minimizes surgical trauma, shortens surgical time and facilitates the postoperative period.
References
1. Leonidas J. C., Brill P. W., Bhan I., et al. Cystic retroperitoneal lymphangioma in infants and children. Radiology. 1978; 127: 203–8.
2. Iyer R., Eftekhari F., Varma D., et al. Cystic retroperitoneal lymphangioma: CT, ultrasound and MR findings. Pediatr Radiol. 1993; 23: 305–6.
3. Irvine A. D., Sweeney L., Corbett J. R. Lymphangioma circumscriptum associated with paravesical cystic retroperitoneal lymphangioma. Br J Dermatol. 1996; 134: 1135–7.
4. Waldhausen J. H., Holterman M. J., Tapper D. Identification and surgical management of cystic retroperitoneal lymphangioma in children. Pediatr Surg Int. 1996; 11: 283–5.
5. Meyer T., Stöhr G., Post S., et al. Retroperitoneal lymphangioma presenting as a mesenteric cyst. Eur J Radiol. 1995; 21: 143–4.
6. Sokolov Yu. Yu. Khirurgicheskie vmeshatel'stva u detei s vnutribryushnymi limfangiomami / Yu. Yu. Sokolov [i dr.] // Rossiiskii vestnik detskoi khirurgii, anesteziologii, reanimatologii. – 2014. – (1): 20–4. – Sokolov Yu. Yu., Donskoy D. V., Vilesov A. V. et al. Surgical interventions in children with intra-abdominal lymphangiomas. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2014; (1): 20–4. (in Russian)
7. Freud E., Farkash U., Cassella R., et al. Childhood retroperitoneal lymphangioma presenting following minor trauma. Injury. 1999; 30: 380–3.
8. Ol'khova E. B. Ul'trazvukovaya diagnostika mezenterial'nykh limfangiom u detei / E. B. Ol'khova [i dr.] // Radiologicheskaya praktika. – 2017. – 65 (5): 6–20. – Olkhova E. B., Mukaseeva T. V., Sokolov Yu. Yu., Bibikova E. E. Ultrasonic diagnosis of mesenteric lymphangiomas in children. Radiologicheskaya praktika. 2017; 65 (5): 6–20. (in Russian)
9. Khetarpal R., Halwai G., Marwaha R. K., et al. Retro-peritoneal cystic lymphangioma in association with fetal hydantoin syndrome. Indian J Pediatr. 1999; 66: 294–7.
10. Shankar K. R., Roche C. J., Carty H. M., et al. Cystic retroperitoneal lymphangioma: treatment by image-guided percutaneous catheter drainage and sclerotherapy. Eur Radiol. 2001; 11: 1021–3.
11. Sharoev T. A. Limfangiomy bryzheiki tonkoi kishki u detei (obzor literatury i sobstvennye klinicheskie nablyudeniya) / T. A. Sharoev [i dr.] // Rossiiskii vestnik detskoi khirurgii, anesteziologii i reanimatologii. – 2012. – (2): 58–63. – Sharoev T. A., Burkov I. V., Kovalev D. V. et al. Lymphangiomas of the mesentery of the small intestine in children (literature review and own clinical observations). Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2012; (2): 58–63. (in Russian)
12. Litovka V. K. Obshirnaya kistoznaya limfgemangioma zabryushinnogo prostranstva malogo taza s rasprostraneniem v pakhovye kanaly i moshonku / V. K. Litovka [i dr.] // Zdorov'e rebenka. – 2012. – 7 (42): 127–9. UDK 616.381-006.2/.314.03-033.5:616.756.26+616.672]-053.2.-089 – Litovka V. K., Zhurilo I. P., Vesely S. V., Latyshov K. V. Extensive cystic lymphhemangioma of the retroperitoneal space of the small pelvis with spread to the inguinal canals and scrotum. Zdorov'e rebyonka. 2012; 7 (42): 127–9. UDC 616.381-006.2/.314.03-033.5:616.756.26+616.672]-053.2.-089 (in Russian)
13. P. de Lagausie A., Bonnard D., Berrebi O., Lepretre L., Statopoulos A., Delarue J.-M. Guys. Abdominal lymphangiomas in children: interest of the laparoscopic approach. Surg Endosc. 2007; 21: 1153–7. https://doi.org/10.1007/s00464-006-9091-x
14. So Hyun Nam, Dae Yeon Kim, Seong Chul Kim, In Koo Kim. The surgical experience for retroperitoneal, mesenteric and omental cyst in children. J Korean Surg Soc. 2012; 83: 102–6. https://doi.org/10.4174/jkss.2012.83.2.102
15. Rani D. V., Srilakshmi R., Malathi S., et al. Unusual presentation of a retroperitoneal lymphangioma. Indian J. Pediatr. 2006; 73: 617–8.
16. Wildhaber B. E., Chardot C., Coultre C. L., et al. Total laparoscopic excision of retroperitoneal cystic lymphangioma. J Laparoendosc Adv Surg Tech. 2006; 16: 530–3.
17. Wilson S. R., Bohrer S., Losada R., et al. Retroperitoneal lymphangioma: an unusual location and presentation. J Pediatr Surg. 2006; 41: 603–5.
18. Pratap A., Tiwari A., Sah B. P., et al. Infected retroperitoneal cystic lymphangioma masquerading as psoas abscess. Urol Int. 2008; 80 (3): 325–7. discussion 328. https://doi.org/10.1159/000127351
19. Poroes Fabio, Petermann David, Andrejevic-Blant Snezana, Labgaa Ismail, Di Mare Luca. Pediatric cystic lymphangioma of the retroperitoneum. A case report and review of the literature. Medicine. July 10, 2020; 99 (28): e20827. https://doi.org/10.1097/MD.0000000000020827
20. Olivieri S., Nanni L., De Gaetano A.M., Manganaro L. Complete Resolution of Retroperitoneal Lymphangioma with a Single Trial of OK-432 in an Infant. Pediatrics and Neonatology. 2016; (57): 240–3. https://doi.org/10.1016/j.pedneo.2013.06.011
21. Singh R. R., Govindarajan K. K., Bowen C., et al. Retroperitoneal cystic lymphangioma: a rare presentation in childhood, treated laparoscopically. J Laparoendosc Adv Surg Tech A. 2009; 19: 249–50.
22. Gümüştaş O. G., Sanal M., Güner O., et al. Retroperitoneal cystic lymphangioma: a diagnostic and surgical challenge. Case Rep Pediatr. 2013; 2013: 1–3.
23. Barbara E. Wildhaber, Shristophe Shardot, Claude le Soultre, Vernard Genin. Total laparoscopic excision of retroperitoneal systic lymphangioma. Journal of laparoendoscopic & advanced surgical techniques. 2006; 16 (5): 530–3
24. Amodeo I., Cavallaro G., Raffaeli G., Colombo L., Fumagalli M. Abdominal cystic lymphangioma in a term newborn. A case report and update of new treatments. Medicine. 2017; 96 (8): e5984. https://doi.org/10.1097/MD.0000000000005984
25. Brian K. P., Yu-Meng Tan, Hock-Soo Ong. Intra-abdominal and retroperitoneal lymphangiomas in pediatric and adult patients. World J. Surg. 2005; 29: 837–40. https://doi.org/10.1007/s00268-005-7794-0
