51例Marjolin's溃疡临床特点与治疗分析  

Clinical characteristics and therapeutic analysis of 51 patients with Marjolin's ulcers

作　　者：沈锐[1] 张金明[2] 张凤刚[1] 陈晓东[1] 杨荣华[1] 杜永军[3] 徐路生[3] 杜学亮[3] 陈平[3] 

机构地区：[1]佛山市第一人民医院烧伤整形外科,528000 [2]中山大学第二附属医院整形外科,广州450120 [3]佛山市第一人民医院美容整形外科,528000

出　　处：《中华损伤与修复杂志（电子版）》2015年第5期32-37,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：广东省医学科研基金资助项目(A2012637)

摘　　要：目的 探讨Marjolin＇s溃疡,即瘢痕癌的临床特点与治疗。方法 回顾性分析2001年1月至2013年9月佛山市第一人民医院烧伤整形外科和中山大学附属第二医院整形外科收治的Marjolin＇s溃疡患者51例,就患者性别、年龄、溃疡癌变所需时间、溃疡原因、溃疡治疗病史、肿瘤病理类型、治疗与预后等进行回顾性分析。另外,对11例肿瘤深部侵犯、高度怀疑哨淋巴结转移的Marjolin＇s溃疡患者应用PET-CT检查结合B型超声下的穿刺活检,确定有无哨淋巴结转移。患者随访时间不一,直至死亡。结果 51例Marjolin＇s溃疡中,男22例,女29例。年龄32-89岁,平均64.15岁。溃疡癌变成鳞癌时间平均13.42年,癌变成恶性黑色素瘤时间平均2.47年。溃疡癌变成上皮样肉瘤1例,为时2年。溃疡癌变成基底细胞癌1例,为时3年。有4种病理类型：鳞状细胞癌43例,黑色素瘤6例,基底细胞癌、上皮样肉瘤各1例。Marjolin＇s溃疡中鳞癌哨淋巴结转移率30.82%,远处转移率9.09%;黑色素瘤淋巴结转移率66.67%,远处转移率33.33%。11例Marjolin＇s溃疡患者行PET-CT检查结合B型超声下的穿刺活检,判定哨淋巴结转移准确率100%。43例鳞状细胞癌中,27例无深部侵犯,无淋巴结转移,行扩大切除、植皮或皮瓣手术,1例患者因3年后出现转移死亡。5例肿瘤深部侵犯,无转移,其中4例给予截肢,存活,1例患者拒绝截肢,1年后出现转移死亡。11例患者鳞状细胞癌深部侵犯,并哨淋巴结转移,其中9例给予截肢并淋巴结清扫,8例存活,1例患者给予截肢并淋巴结清扫术后2年,远处转移死亡。1例患者不同意手术,2年后出现转移死亡。1例患者多发哨淋巴结转移,无法手术,1年后死亡。6例黑色素瘤中,2例患者足部黑色素瘤无转移,给予扩大切除、植皮或皮瓣手术,2例患者足部黑色素瘤并哨淋巴结转移,扩大切除、植皮或截肢,并淋巴结清扫存活。1例患者足部黑色素�Objective To explore the epidemiology and therapeutic methods of Marjolin＇s ulcer. Methods Between January 2001 and September 2013, fifty-one patients with Marjolin＇s ulcers were admitted to the departments of Burn and Plastic Surgery of the First People＇s Hospital of Foshan and the Second Affiliated Hospital of Sun Yat-sen University. Data were collected including their age, gender, time from initial ulceration to carcinomatous change, cause of initial ulceration, history of ulcer treatment, surgical treatment and follow-up results. The associations between pathological type and metastasis and between location of squamous cell carcinoma （SCC） and metastasis were analyzed. Eleven patients with deep, aggressive SCC or melanoma and suspected sentinel lymph node metastasis underwent positron emission tomography-computer tomography （PET-CT） and B-mode ultrasound-guided biopsy. All patients were followed up until death. Results The 51 patients with Marjolin＇s ulcers included 22 male （43.14%） and 29 female （56.86%） with mean age of 64.15 years （range, 32-89 years）. The mean time from initial ulceration to diagnosis of SCC was 13.42 years （range, 6 months -54 years） and the time to diagnosis of melanoma was 2.47 years （range, 3 months -10 years） and one patient developed epitheliod sarcoma after 2 years and one developed basal cell carcinomas after 3 years. Four pathological types include 43 cases of SCC, 6 cases of melanoma, 1 case of epitheliod sarcoma and 1 case of basal cell carcinomas. Among patients with SCC, 30.82% had sentinel lymph node metastasis and 9.09% distant metastasis while patients with melanoma, 66.67% had sentinel lymph node metastasis and 33.33% distant metasrasis. PET-CT and B-mode ultrasound were successfully used for detecting early lymph node metastasis in 11 Marjolin＇s ulcer patients with 100% accuracy rate. For 27 patient of SCC without metastasis and aggressive tumor, extended resection and skin graft or skin flap operation were conformed. Only one patien

关 键 词：癌 鳞状细胞 皮肤溃疡 淋巴转移 Marjolin's溃疡 

分 类 号：R739.5[医药卫生—肿瘤]