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頸部良性囊狀病灶使用OK-432硬化治療的療效分析

Efficacy of OK-432 Sclerotherapy for Benign Cystic Lesions of the Neck

摘要


背景:OK-432是一種鏈球菌萃取製劑,廣泛被用於癌症的免疫治療。1987年Ogita提出使用OK-432注射於淋巴管瘤内引起局部發炎和纖維化反應使病灶縮小,其後陸續有文獻報導OK-432用於治療各種頸部良性囊腫作為手術切除的替代療法,唯國内相關治療經驗之論文較爲欠缺。本研究旨在探討本院過去使用OK-432治療頸部良性囊腫的成效,作為日後治療策略的參考。方法:回溯在本院因頸部良性囊腫接受OK-432硬化治療之個案病歷記錄,擷取病史、影像檢查結果、治療成效及併發症等,加以整理及分析。結果:自2012/01/01至2017/12/31,共計11名病患接受了OK-432硬化治療。臨床診斷包括淋巴管瘤7名、鰓裂囊腫3名、頦下黏液囊腫1名。11名患者中,有9名(81.8%)治療反應良好。6名反應良好的病患具治療後之影像學資料可供比較,其治療後的病灶體積較原體積平均縮減了86.6%。2名患者反應不佳而後續接受手術切除。病患接受OK-432治療後常見副作用為局部疼痛(72.7%)、發紅腫脹(63.6%)、輕度發燒(45.5%)等。除此之外,我們也發現54.5%患者治療後會產生局部淋巴結腫大情形,為之前文獻所未曾報告的副作用。這些症狀均爲自限性且無嚴重併發症。結論:頸部良性囊腫(尤其是淋巴管瘤)使用OK-432硬化治療副作用輕微且反應良好,是手術切除外的另一治療選擇。

並列摘要


BACKGROUND: OK-432 is a lyophilized mixture of Streptococcus pyogenes with antineoplastic activity. It was first used as a sclerosing agent to treat lymphatic malformation in 1987. Since then, OK-432 sclerotherapy has also been conducted in various kinds of benign cystic lesions, with promising results. However, although OK- 432 sclerosing therapy it now recognized as a treatment option for benign cystic lesions in addition to surgery, there are only few studies reporting its treatment efficiency in Taiwan. The purpose of this study is to demonstrate the efficacy of OK-432 sclerotherapy in treating benign cystic lesions of the neck. METHODS: We conducted a retrospective chart review of patients who received OK- 432 sclerotherapy at Department of Otolaryngology, National Cheng Kung University Hospital. The efficacy of OK-432 sclerotherapy for various kinds of benign cystic lesions was then evaluated. RESULTS: From Jan. 2012 to Dec. 2017, a total of 11 patients (including 7 lymphangioma, 3 branchial cleft cyst and 1 mucocele) received OK-432 sclerotherapy for benign cystic lesion of the neck. Nine (81.8%) of 11 cystic lesions responded well, including 6 lymphangiomas (85.7%, 6/7), 2 branchial cleft cysts (66.7%, 2/3) and 1 submental mucocele. The average post-treatment volume reduction was 86.6%. Two of the 11 patients had a poor response and subsequently received operation for salvage. The most common treatment-related side effects were pain (72.7%), local swelling (63.6%), low-grade fever (45.5%) and regional lymphadenopathy (54.5%). All these symptoms were self-limited and subsided gradually without major complication. CONCLUSION: OK-432 sclerotherapy is a safe and effective treatment option for benign cystic lesions of the neck.

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