Perioperative managements of infant patients with Kasabach-Merritt phenomenon
10.3760/cma.j.cn114453-20200915-00499
- VernacularTitle:卡梅现象患儿围手术期治疗体会
- Author:
Xiaonan GUO
1
;
Changxian DONG
;
Yubin GONG
;
Hongyu ZHANG
;
Yuanfang ZHANG
;
Xiaolin WANG
Author Information
1. 河南省人民医院血管瘤科，郑州 450003
- Keywords:
Vascular tumor;
Kasabach-Merritt phenomenon;
Perioperative;
Surgical treatment;
Kaposiform hemangioendothelioma;
Tufted angioma
- From:
Chinese Journal of Plastic Surgery
2021;37(9):1036-1040
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate more safe, effective and standard perioperative managements of infant patients with Kasabach-Merritt phenomenon (KMP).Methods:We made a retrospective analysis on the clinical data of KMP infant patients, who received surgical intervention in our department between January 2017 and September 2019. Inclusion criteria : (1) diagnosed as KMP that characterized by a large hemangioma (located in trunk or limb), profound thrombocytopenia and consumptive coagulopathy; (2) received surgical treatment in our center during January 2017 and September 2019; (3) age ≤1 year. Before surgical treatment, all the patients were given glucocorticoid and continued to the operation day in the sensitive group. The insensitive group received single large dose of platelet (PLT) transfusion 1 day before surgery, for the purpose of correcting thrombocytopenia and coagulopathy. Endotracheal intubation and intravenous anesthesia, combined with deep vein catheterization, arterial puncture catheterization and continuous invasive blood pressure monitoring were used to maintain hemodynamic stability. Radical resection of the tumor, combined with flap plasty or in situ skin grafting was carried out when necessary; after the operation, the endotracheal tube was routinely taken to ICU, and the endotracheal tube was removed as appropriate after the recovery of respiratory and circulation. The patient was kept overnight in ICU, and patient was transferred out after evaluation of stability. The dynamic changes of platelet were monitored and nutritional support was strengthened. Patients with lesions in limbs (except those with in situ skin grafting) were given passive rehabilitation training on the third day after surgery. The patients were followed up for 6-36 months. Routine blood examination, coagulation function, color Doppler ultrasonography and MRI were performed when necessary. The range of motion and muscle strength of adjacent joints were examined during the follow-up visit. Results:A total of 55 infant patients with KMP were included in this study. Peripheral blood test at 1 h before surgery showed platelets > 100×10 9/L in 54 cases and > 80×10 9/L in 1 case, and hemoglobin was corrected to more than 10 g/L. The operation time was 48-135 min, with an average of 87 min. There was no intraoperative or postoperative death. It took 4 to 36 hours for platelet to return to normal level, with an average of 8.4 hours. All surgical specimens were found to be KMP. The hospital stay was 9-30 d, with an average period of 16.7 d. Delayed incision healing in 3 cases, scar contracture in 1 case, scar hyperplasia in 3 cases. There was no death during the follow-up period, and the platelet was stable in the normal range. Conclusions:Surgical treatment of vascular tumors complicated with KMP has definite curative effect, rapid effect, short course of treatment and low cost. A series of perioperative treatments, including active preoperative preparation, effective coagulation function correction measures, perfect anesthesia and monitoring methods, stable hemodynamic support, fine surgical operation and early postoperative rehabilitation exercise are the necessary guarantee for the success of surgical treatment.
