缝线作为标记的Mohs外科技术在皮肤软组织恶性肿瘤外科治疗中的应用  

Application of Molts surgery with suture as marker in surgical treatment of skin or soft tissue malignant tumors

作　　者：张晨[1] 余江[2] 王娜[1] 孙琳[1] 何祯平[1] 陈灿[1] 胡波[3] 王志军[1] 

机构地区：[1]大连大学附属新华医院整形外科,辽宁大连116021 [2]中国医科大学附属盛京医院整形外科 [3]大连大学附属新华医院病理科,辽宁大连116021

出　　处：《中国美容整形外科杂志》2009年第7期409-412,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 介绍Mohs外科理论及缝线作为标记的Mohs外科技术在皮肤软组织恶性肿瘤外科治疗中的应用。方法 在过去的5年里，对55例皮肤软组织恶性肿瘤的患者实施Mohs外科手术，其中男性35例，女性20例。术中切除肿瘤的范围平均为肿瘤边缘外10mm。在切除肿瘤之前，先将肿瘤分成若干区，再用刀片将术区的标记及分区情况，用划痕记录在皮肤表面，以备术中参考。切开皮肤后，用丝线标记切除物各区的边缘。通常缝合1针为Ⅰ区，缝合2针为Ⅱ区，以此类推。当肿瘤的直径大于5cm时，将其纵向分为2块，每块按前述分区，两块肿瘤的标记线采用不同颜色，以便区分。标记后将肿瘤切下，标记情况绘制在病理申请单上，与标本一同送至病理科。病理医师根据标记取材做术中病理检查。外科医师根据病理结果判定肿瘤是否完全切除。结果 4／55例在术中发现有1个区域的边缘仍存在病灶，1／55发现有2个区域的边缘存在病灶。随访43例患者达2年。其中41例存活，2例死亡。死亡患者均为恶性黑色瘤复发并远处转移。1例腰骶部恶性纤维细胞瘤在术后14个月复发，再次手术。结论 缝线作为标记的Mohs外科技术，在皮肤软组织恶性肿瘤外科治疗中是一种有效而又经济的治疗手段。Objective To introduce Mohs surgery and its use in surgical treatment of skin or soft tissue malignant tumors with suture as marker when this theory was applied. Methods In the past 5 years, 55 patients （35 male and 20 female） with skin or soft tissue malignant tumor underwent Mohs surgery. During operation, the average linear extent of tumor at the surgical margin was 10 mm. Several regions of the lesion were marked off with blade as reference lines before the excision of the lesion ; then the margin of removed tissue was marked by sutures. Zone Ⅰ was marked with one suture, zone Ⅱ with two sutures . When the diameter of the tumor was more than 5 cm, the removed lesion was first divided into two parts and both were then marked according to the same method as the tumor less than 5 cm with different color sutures. The marking details were also drawn on a paper and then were sent to the department of pathology together with the marked specimen. Results Among the samples of 55 cases, 4 were found to have tumor foci in the surgical margin in zone Ⅰ , and 1 was found tumor foci in zones Ⅱ. 43 patients were followed up for 2 years. 41 survived and 2 died of the malignant melanoma recurrence and widespread metastasis. One case with malignant fibrosarcoma recurred at 14 months postoperatively and performed surgery again. Conclusion Mohs surgery with suture as marker is an effective and economical method in surgical treatment of skin or soft tissue malignant tumors.

关 键 词：皮肤 软组织 恶性肿瘤 外科治疗 MOHS 

分 类 号：R622[医药卫生—整形外科]