낭포성 임파관종에 대한 임상적 고찰

Abstract

[한글]

1965년 1월부터 1979년 12월까지 15년동안 연세대학교 의과대학 외과학 교실에서 치험한 102예의 낭포성 임파관종 환자에 대해 이의 발병기전, 임상소견, 치료 및 합병증 등을 종합분석하였다. 102예중 95예는 병리조직학적으로 낭포성 임파관종임이 확진되었고 나머지 7예에서는 임상소견으로 진단되었다.

연령별 분포는 약 1/2이 1세이전에 발견되었으며 61%가 2세이전에 발견되었다. 남자 53예, 여자 49예로 성별차이는 뚜렷하지 않았다. 주증상으로는 종괴 또는 종창을 호소하는 경우가 83%로 가장 많았고 호발부위는 경부로 약 51%에서 나타났으며 그밖에 액와부, 두부, 체간 및 신체 각 부위에서 볼 수 있었다. 102예중 99예에서 수술을 시행하였으며 85예에서 완전절제술을 시행하였다. 수술후 합병증은 모두 15예에서 있었는데 이중 3예에서 안면신경마비가 나타났다. 5예에서 사망하였으며 이중 4예가 1세미만이었다.

낭포성 임파관종의 치료는 완전절제가 가장 좋은 방법이긴 하나 임파관종의 발생부위나 주위 조직의 침윤때문에 완전절제가 불가능할 경우는 무리하게 완전절제를 시도하기 보다는 부분절제술로 크기를 줄인 후에 관찰하는 것이 좋다고 생각되며 수술의 시기는 특히 영아에서 발견되는 즉시 시행하는 것이 좋을 것으로 사료된다.

[영문]

The records of the 102 patients with cystic hygroma who were seen at the Department of Surgery, Yonsei University College of Medicine for the period 1965 through 1979 were reviewed. In 95 of these the diagnosis was confirmed histologically, and in the remaining 7 it was on a clinical basis alone.

Characteristically, cystic hygroma present in young; about one-half of the patients in the series were seen before 12-month-old and three-fourths by two years of age. Fifty-three of 102 patients with cystic hygroma were males and 49 were females. Thus, there seemed to be no sex predilection.

The most common complaint, occurring in 83% of the cases, was the presence of a mass or swelling. In a few patients, swallowing difficulty or dyspnea was the main complaint and in patients with infected cyst, pain and fever were combined with a presence of mass.

The most common site was the neck in 51% of the patients and the next was the axilla in 10.8%. The rest were scattered at various sites involving chest wall, mesentery, upper and lower exterimity, retroperitoneum, parotid gland, scapula,

cheek, lip, eye lid, tongue. throat, groin and mediastinum.

In 99 of our 102 patients, operations were performed. Total excision of the lesion was the best treatment and should always be carried out if possible. But it was not always feasible due to massive infiltration or marked adhesion to the surrounding tissue. Total excision was done in 85 cases and nine patients underwent subtotal excision because of massive infiltration. Four cases were managed with incision and drainage and one with aspiration only.

Postoperative complications were noted in 15 patients; wound infection in five, hematoma formation in four, pulmonary complications in three and unilateral facial nerve paralysis in three.

We had five deaths in the series. Four cases were below one year of age and one was 15-month-old. Four babies died because of sepsis with infected cystic hrgroma and one baby was lost because of massive infiltrating cervicomediastinal involvement.