ÇOCUKLARDA LENFANJİOM TEDAVİSİNDE OK-432 KULLANIMI SONUÇLARIMIZ

Year 2006, Volume: 7 Issue: 3, 31 - 34, 01.12.2006

Barlas Etensel Sezen Özkısacık Günyüz Temir Aytaç Karkıner Yeşim Edirne Mesut Yazıcı İrfan Karaca Harun Gürsoy

Abstract

Amaç:Lenfanjiomlarda önceki yıllarda tedavinin temeli cerrahi rezeksiyondu fakat belirgin yara izi, yükseknüks ve organ hasarları gibi önemli komplikasyonlarla karşılaşılıyordu. Son yıllarda alternatif tedavi olaraksklerozan madde OK-432 kullanımı ön plandadır. İki ayrı çocuk cerrahisi merkezinde OK-432 skleroterapisiile tedavi gören olgu serimizi sunuyoruz.Hastalar ve yöntem:1999-2004 yılları arasında iki ayrı çocuk cerrahisi merkezinde OK-432 enjeksiyonu iletedavi gören olguların dosyaları geriye dönük olarak incelendi.Bulgular:5 yıllık bu dönemde 8 çocuk OK-432 ile skleroterapi uygulanarak tedavi edildi. 6 çocukta servikalbölgede, bir çocukta aksilla ve bir çocukta inguinal bölgede lenfanjiom saptandı. Olgularımıza ortalama 3enjeksiyon uygulandı. OK-432 uygulaması sırasında en büyük kistin saptanması, aspirasyon ve enjeksiyoniçin ultrasonografiden faydalanıldı. Makrokistik lezyonlarda başarı yüz güldürücü iken mikrokistik ve miksyapılı lezyonlarda başarı düşüktü.Sonuç:OK-432 ile skleroterapi lenfanjiomlarda özellikle makrokistik olanlarda güvenilir ve etkili bir tedaviyöntemidir. OK-432 tam yanıt alınamayan olgularda lezyon çevresinde fibrozis yaratmadığı için daha sonrayapılacak olan cerrahi işlemi güçleştirmemektedir

Keywords

çocuk, lenfanjiom, skleroterapi, OK-432

OK-432 Treatment Results of Lymphangiomas in Children

Abstract

Objective: Surgery has previously been the mainstay of treatment for lymphangiomas but has attendant problems of marked scarring, high chance of recurrence and potential tissue damage. In recent years alternative management for these lesions involves the intralesional injection of OK-432. We present our series of lymphangiomas treated in two different pediatric surgery centers with OK-432 sclerotheraphy. Patients and method: A retrospective chart review was carried out of children undergoing intralesional OK-432 therapy from two Pediatric Surgery Centers between the years 1999-2004. Results: Eight children underwent OK-432 therapy requiring mean three injections each. Six children had lesions involving in the neck, one involved axilla and one child had an inguinal lesion. Ultrasound was used to localize the major cyst for aspiration and injection. Macrocystic lesions responded well to OK-432 therapy but the response of microcystic or mixed lesions to OK-432 was disappointing. Conclusion: OK-432 appears to be a safe and effective treatment for lymphangiomas especially the macrocystic ones. Another advantage of OK-432 is absence of sclerosis or fibrosis outside the cyst in cases where surgery is later required.

Keywords

child, lymphangioma, sclerotheraphy, OK-432

References

• 1. Degenhardt P, Dieckow B, Mau H. Huge intra- and extrathoracic lymphangioma in a baby successfully treated by sclerotherapy with OK-432. Eur J Pediatr Surg 2006; 16:197-00.
• 2. Luzzatto C, Lo Piccolo R, Fascetti Leon F, Zanon GF, Toffolutti T, Tregnaghi A. Further experience with OK- 432 for lymphangiomas. Pediatr Surg Int 2005; 21:969- 72.
• 3. Wheeler JS, Morreau P, Mahadevan M, Pease P. OK- 432 and lymphatic malformations in children: the Starship Children's Hospital experience. ANZ J Surg 2004; 74:855-8.
• 4. Bloom DC, Perkins JA, Manning SC. Management of lymphatic malformations. Curr Opin Otolaryngol Head Neck Surg 2004; 12:500-4.
• 5. Abantanga FA. Groin and scrotal swellings in children aged 5 years and below: a review of 535 cases. Pediatr Surg Int 2003; 19:446-0.
• 6. Şanlıalp İ, Karnak İ, Tanyel FC, Şenocak ME, Büyükpamukçu N. Sclerotherapy for lymphangioma in children. Int J Pediatr Otorhinolaryngol 2003; 67:795- 0.
• 7. Hall N, Ade-Ajayi N, Brewis C, Roebuck DJ, Kiely EM, Drake DP, Spitz L, Pierro A. Is intralesional injection of OK-432 effective in the treatment of lymphangioma in children? Surgery 2003; 133:238-2.
• 8. Rautio R, Keski-Nisula L, Laranne J, Laasonen E. Treatment of lymphangiomas with OK-432 (Picibanil). Cardiovasc Intervent Radiol 2003; 26:31-6.
• 9. Ogita S, Tsuto T, Tokiwa K, Takahashi T. Treatment of cystic hygroma in children with special reference to OK-432 therapy. Z Kinderchir 1987; 42:279-1.
• 10. Ogita S, Tsuto T, Tokiwa K, Takahashi T. Intracystic injection of OK-432: a new sclerosing therapy for cystic hygroma in children. Br J Surg 1987; 74:690-1.
• 11. Sichel JY, Udassin R, Gozal D, Koplewitz BZ, Dano I, Eliashar R. OK-432 therapy for cervical lymphangioma. Laryngoscope 2004; 114:1805-9.
• 12. Laranne J, Keski-Nisula L, Rautio R, Rautiainen M, Airaksinen M. OK-432 (Picibanil) therapy for lymphangiomas in children. Eur Arch Otorhinolaryngol 2002;259:274-8.
• 13. Brewis C, Pracy JP, Albert DM. Treatment of lymphangiomas of the head and neck in children by intralesional injection of OK-432 (Picibanil). Clin OtolaryngolAllied Sci 2000; 25:130-4.
• 14. Avanoğlu A, Erikçi VS, Ulman İ, Özok G. Lymphangiomas in children. Pediatrik Cerrahi Dergisi 1996; 10:28-1.
• 15. Claesson G, Kuylenstierna R. OK-432 therapy for lymphatic malformation in 32 patients (28 children). Int J Pediatr Otorhinolaryngol 2002; 65:1-6.
• 16. Hancock BJ, St-Vil D, Luks FI, Di Lorenzo M, Blanchard H. Complications of lymphangiomas in children. J Pediatr Surg 1992; 27:220-4.
• 17. Ogita S, Tsuto T, Nakamura K, Deguchi E, Tokiwa K, Iwai N. OK-432 therapy for lymphangioma in children: why and how does it work? J Pediatr Surg 1996; 31:477-0.
• 18. Ogita S, Tsuto T, Nakamura K, Deguchi E, Iwai N. OK- 432 therapy in 64 patients with lymphangioma. J Pediatr Surg 1994; 29:784-5.
• 19. Fujino A, Moriya Y, Morikawa Y, Hoshino K, Watanabe T, Shimojima N, Kitajima M. A role of cytokines in OK-432 injection therapy for cystic lymphangioma: an approach to the mechanism. J Pediatr Surg 2003; 38:1806-9.
• 20. Giguere CM, Bauman NM, Sato Y, Burke DK, Greinwald JH, Pransky S, Kelley P, Georgeson K, Smith RJ. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multiinstitutional trial. Arch Otolaryngol Head Neck Surg 2002;128:1137-44.
• 21. Banieghbal B, Davies MR. Guidelines for the successful treatment of lymphangioma with OK-432. Eur J Pediatr Surg 2003;13:103-7.
• 22. Ogita K, Suita S, Taguchi T, Yamanouchi T, Masumoto K, Tsukimori K, Nakano H. Outcome of fetal cystic hygroma and experience of intrauterine treatment. Fetal Diagn Ther 2001;16:105-10.