Kasabach—Merritt综合征治疗中自体原位植皮术的应用  

Application of autologous skin grafting for Kasabach-Merritt syndrome

作　　者：刘大看[1] 郭晓楠[1] 左松[1] 董长宪[1] Liu Dakan Guo Xiaonan Zuo Song Dong Changxian(Department of Hemangioma Surgery, Henan Provincial People＇s Hospital, Zhengzhou 450003, Chin)

机构地区：[1]河南省人民医院血管瘤外科,郑州450003

出　　处：《中华小儿外科杂志》2017年第1期25-27,共3页Chinese Journal of Pediatric Surgery

基　　金：河南省卫生厅省部共建项目（2011010010）

摘　　要：目的对Kasabach-Merritt综合征手术治疗过程中使用自体原位植皮术，评价其治疗效果，提出一种新的手术治疗方式。方法回顾性分析2010年至2015年间自体原位植皮手术治疗的Kasabach-Merritt综合征患儿23例，病例纳入标准：均为瘤体分布弥散，皮肤大面积（〉5cm×5cm）异常，手术切除瘤体后创面缝合困难；非手术治疗方法无效；血小板值在2×10^9／L^31×10^9／L。23例Kasabach-Merritt综合征患儿瘤体均位于四肢，上肢6例，下肢17例；男9例，女14例；年龄7d～9个月。总结该手术治疗方法的手术要点及术中、术后处理，分析治愈率及术后并发症。术后均经病理学检查证实为卡波西样血管内皮瘤（kaposiform hemangioendothelioma，KHE）20例，丛状血管瘤（tuftedangioma，TA）3例。结果23例患儿均在术后1周内血小板值恢复正常，随访1-5年，治愈率为100％；18例患儿自体皮片原位移植全部成活，有3例成活面积约90％，经后续换药处理后愈合，2例原位皮片移植成活约60％，行二期皮肤移植修补手术后治愈，术后并发症少。结论手术治疗Kasabach-Merritt综合征可作为有效的治疗方法，本组资料显示，自体原位植皮术作为一种新的手术方式，治愈率100％，术后并发症少，其对符合适应证者是一种可选择治疗手段。Objective To introduce one surgical approach for Kasabach-Merritt syndrome by autologous skin grafting and evaluated the effect of surgical treatment. Methods Retrospective analysis of autologous skin grafting was performed for 23 cases of Kasabach-Merritt syndrome. The area of tumor dispersion was 〉5 cm × 5 cm. Non-operative treatment was ineffective. Platelet count was under 2-31 × 10^9/L. All patients were confirmed postoperatively by pathological examination. The pathological diagnoses were KHE （kaposiform hernangioendothelioma, n = 20） and TA （tufted angioma, n = 3）. Results All platelet counts recovered to normal within at 1 week post-operation. During a follow-up period of 1-5 years, the curative rate was 100%. And autologous skin grafts survived 100% （n = 18）, 90%＆ healed after dressing （n=3） and 60% ＆ healed after repairing （n= 2）. Conclusions Autologous skin grafting is efficacious and has few complications for Kasabach- Merritt syndrome, especially tumor involvement of large skin area.

关 键 词：卡萨巴赫-梅里特综合征 皮肤移植术 全厚皮片 

分 类 号：R726.5[医药卫生—儿科]