bubble_chart Overview

Lymphangioma (lymph-vessel tumor), resulting from the proliferation and dilation of lymphatic vessels, is a benign tumor. It primarily consists of lumens lined by endothelial cells and filled with lymph fluid. Based on differences in tissue structure, it is clinically classified into three types: capillary lymphangioma, cavernous lymphangioma, and cystic lymphangioma. While it is more commonly observed in children, clinical observations by the author indicate that adult cases are also frequent. The tumor grows slowly, and spontaneous regression is extremely rare.

bubble_chart Treatment Measures

Complications or those that continue to enlarge should be surgically removed. For infants, due to the extensive nature of the surgery and significant blood loss, thorough preoperative preparation is essential.

Laser Surgery

Laser therapy is highly effective for lymphangiomas. It is particularly convenient for smaller lymphangiomas. For smaller capillary lymphangiomas, especially those mixed with small blood vessels and presenting as pale red or purplish-red, conventional treatments may result in slightly more bleeding, whereas laser therapy can achieve a clean and complete cure. Typically, after injecting 1–2% lidocaine at the base of the lymphangioma for anesthesia, CO₂ laser (15W power) and Nd:YAG laser (20W power) are used to directly vaporize the lymphangioma. The depth should reach the base of the lymphangioma. The wavelength of Nd:YAG laser differs from CO₂ laser, so care must be taken not to vaporize too deeply, as the injury would be more severe than with CO₂ laser, and recovery would take longer. After the procedure, apply Chinese Gentian violet solution to the wound. Avoid strongly irritating or high-temperature foods postoperatively. Administer high-dose oral vitamin therapy, and the wound will heal within a week. Antibiotics are unnecessary.

Among lymphangiomas, the treatment of cavernous lymphangiomas is more complex. Since these occur in the skin, subcutaneous tissue, or intermuscular connective tissue spaces, Nd:YAG laser therapy is relatively easier and yields excellent results. Particularly for multilocular cysts or those with a large, sponge-like structure, traditional surgical excision causes more tissue injury. Without skin grafting or other treatments, functional deficits are inevitable.

Surgical Treatment

Using Nd:YAG laser, a 60cm-long quartz fiber scalpel is sterilized with 5% iodine tincture, followed by 75% ethanol for deiodination. Strict aseptic technique is observed, with thorough disinfection and draping of the surgical area. After local anesthesia, the quartz fiber scalpel is inserted directly into the lymphangioma to deliver the laser. The laser output and duration are adjusted based on the tumor size. For multilocular, tortuous capillary lymphangiomas, higher laser power may be required, with a relatively prolonged application. The incision for the fiber scalpel may be slightly enlarged by 1–2mm. After insertion, the scalpel is rotated circumferentially to cut the tumor, with intervals of 1–2mm between insertions, avoiding excessive density. The depth depends on the tumor.

For cavernous lymphangiomas in the skin, the fiber scalpel is applied perpendicular to the skin in a multi-point contact manner. For those in subcutaneous tissue, the optimal entry point is chosen for ease of operation, and the laser is delivered subcutaneously in a closed cutting manner. For cavernous lymphangiomas in intermuscular connective tissue spaces, once diagnosed, Nd:YAG laser scalpel is inserted for cutting under strict aseptic conditions.

Deeper tumors may require open surgery. Following standard surgical procedures, the skin is incised with the laser, and tissues are dissected layer by layer until the tumor is reached. Clinically, lymphangiomas in deeper locations are harder to diagnose.

The author often differentiates them from simple cysts, hematomas, or solid tumors during surgery by exposing the tumor and confirms the diagnosis via biopsy. In open surgery, the Nd:YAG fiber scalpel is used to excise the tumor at its margins, ensuring no residual lesion. After tumor removal, the wound is sutured layer by layer anatomically.

The treatment for lymphangiomas occurring in the tongue or lips is the same. Larger lesions may regain near-original size after laser therapy. For giant lymphangiomas in the lips or tongue that remain large post-laser treatment, postoperative plastic surgery may be performed. Since the lymphangioma is eliminated after laser therapy, leaving only fibrous healing, partial tissue excision can restore physiological volume and function.

Cystic hygromas, being non-adherent to surrounding tissues, are treated with comprehensive laser surgery tailored to their location.

For patients with neck lesions, under strict aseptic technique and local anesthesia, an incision is selected according to anatomical landmarks. The skin is incised (neck skin incisions are made with a surgical scalpel, as post-healing scar formation is less noticeable and more cosmetically favorable compared to laser scalpel incisions, which leave more prominent scars). Subcutaneous tissue is dissected using a laser until the tumor is reached. During surgery, care must be taken to avoid damaging major organs such as the carotid pulse, nerve trunks, and primary nerve branches. The cyst is clamped with skin forceps, and its contents are completely drained. A CO₂

laser or Nd:YAG laser scalpel is then used to meticulously dissect the cyst wall intact. During dissection, laser power should be carefully controlled to avoid excessive intensity. If dissection proves difficult, the cyst wall is irradiated with the laser, and any charred tissue is removed with sterile wet gauze. The cystic cavity is then closed, and the incision is sutured. Sutures are removed 7–10 days postoperatively.

Extending to the surrounding lymphangioma, laser surgery does not require forced dissection. After draining the lymphatic fluid within the tumor, the laser can be used to irradiate the cyst wall. During irradiation, no fistula disease should be left. Generally, after laser irradiation of the cyst wall, the cyst cavity is closed, and it heals on its own without re-secretion forming a lymphangioma. For deeper cyst cavities, a fiberoptic bronchoscope or other suitable fiber endoscope is used to enter the cavity through a small incision, evacuate the fluid inside (discharged via the endoscope tube with foot-pedal suction), and appropriately inflate it. The Nd:YAG laser scalpel is then introduced through the instrument channel to irradiate the cavity wall for treatment. During the procedure, no fistula disease should occur, leaving no unirradiated areas of the cavity wall. After the procedure, all air in the cavity is evacuated to allow natural fibrous healing.