面部基底细胞癌和鳞状细胞癌切除的美容修复  

Resection of facial basal cell carcinoma and squamous cell carcinoma and their cosmetic repair

作　　者：柴密[1] 陈犹白[1] 牛泽浩 舒军 郭伶俐[1] 雷永红[1] 陶然[1] 韩岩[1] Chai Mi;Chen Youbai;Niu Zehao;Shu Jun;Gou Lingli;Lei Yonghong;Tao Ran;Han Yan(Department of Plastic Surgery,Chinese PLA General Hospital First Medical Center,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心整形修复科,北京100853

出　　处：《中华医学美学美容杂志》2020年第6期461-464,共4页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨面部基底细胞癌(基癌)和鳞状细胞癌(鳞癌)切除后缺损的修复方法,分析影响术后美容效果的主要因素。方法2013年1月至2019年5月,于解放军总医院第一医学中心整形修复科行手术扩大切除并一期美容修复的90例面部基底细胞癌和鳞状细胞癌患者,男46例,女44例,年龄19~97(64.5±15.3)岁。探讨肿瘤部位、手术切除范围、修复方式等。由其他医师和患者分别对出院时的美容效果(包括对称性、器官牵拉变形、局部平整度、色泽、质地)进行评分。结果局部皮瓣是基底细胞癌修复常用方法,其次为游离植皮、直接缝合。游离植皮是鳞状细胞癌修复常用方法,其次是局部皮瓣,直接缝合、游离皮瓣。70%患者(基癌患者40例、鳞癌患者23例)修复后美容效果评价为优,20%(基癌患者15例,鳞癌患者3例)为良,10%(基癌患者4例,鳞癌患者5例)为差,两组肿瘤的美容效果比较,差异无统计学意义(P>0.05)。直接缝合的美容效果显著高于其他几种修复方式。结论面部基底细胞癌和鳞状细胞癌通过扩大切除和选择适当的修复方法,均可达到较好的肿瘤学和美容效果。Objective To compare the reconstruction methods to repair the defects after surgical resection of facial basal cell carcinoma(BCC)and squamous cell carcinoma(SCC)and to analyze the main factors influencing the postoperative cosmetic effect of both.Methods Ninety patients with facial primary BCC/SCC treated at the Department of Plastic and Reconstructive Surgery,First Medical Center,Chinese PLA General Hospital from 2013 to 2019 were studied.The predictive variables were tumor type,site,size,surgical resection range and repair method.The primary outcome was the cosmetic effect after repair.Other doctors and patients comprehensively evaluated the cosmetic effects in the three levels of excellent,good and poor.Results BCCs mainly occurred in the nose,eyes and cheeks,and SCCs were most common in the cheeks,nose and lips.Local flap was the most common reconstruction method for BCC,followed by skin grafting,and direct closure.Skin grafting was the most common reconstruction method for SCC,followed by local flap,direct closure,and free flap.Evaluation of cosmetic repair effect was excellent(70%),good(20%)and poor(10%).There was no significant difference between the two groups.The cosmetic effect of direct closure was significantly higher than other repair methods.Conclusions Both facial BCC and SCC can achieve good oncologic and cosmetic effects by extended excision and selection of appropriate repair methods.

关 键 词：癌 基底细胞 癌 鳞状细胞 修复外科手术 美容技术 皮瓣 

分 类 号：R739.5[医药卫生—肿瘤]