肿胀麻醉联合皮肤软组织扩张术修复先天性巨痣41例  

Tumescent anesthesia combined with skin and soft tissue expansion for the repair of 41 cases of congenital giant melanocytic nevi

作　　者：赵涛[1] 郭伟楠[1] 陈慧[1] 王刚[1] 李冰[1] Zhao Tao;Guo Weinan;Chen Hui;Wang Gang;Li Bing(Department of Dermatology,Xijing Hospital,The Fourth Military Medical University,Xi′an 710032,China)

机构地区：[1]第四军医大学西京皮肤医院,西安710032

出　　处：《中华皮肤科杂志》2022年第1期65-67,共3页Chinese Journal of Dermatology

摘　　要：目的探讨肿胀麻醉联合皮肤软组织扩张术修复先天性巨痣的效果。方法2015年7月至2019年12月在第四军医大学西京皮肤医院收集41例先天性巨痣患者,男24例,女17例,年龄7~45岁,皮损面积5 cm×12 cm~12 cm×18 cm;皮损位于头皮13例,面部18例,躯干10例。术前依据体重、手术时间、皮损面积等调整肿胀液配方组成,利多卡因总剂量<35 mg/kg,血浆峰值<4 mg/L。所有病例均在肿胀麻醉下完成扩张器置入及二期皮瓣转移。结果41例患者术中肿胀麻醉效果理想,数字分级评分法疼痛评分(1.82±0.54)分,手术视野及剥离层次清晰,出血少,无相应并发症。随访3~36个月,修复皮瓣与周围皮肤组织匹配良好,切口线相对隐蔽,瘢痕平软。结论肿胀麻醉技术安全、有效,与皮肤软组织扩张术联合应用治疗先天性巨痣可以有效降低术后并发症的发生率,值得临床推广。Objective To investigate the efficacy of tumescent anesthesia combined with skin and soft tissue expansion for the repair of congenital giant melanocytic nevi.Methods From July 2015 to December 2019,41 patients with congenital giant melanocytic nevi,including 24 males and 17 females aged 7-45 years,were collected from the Department of Dermatology,Xijing Hospital,the Fourth Military Medical University.Skin lesions ranged from 5 cm×12 cm to 12 cm×18 cm in size,and were located on the scalp in 13 cases,on the face in 18 cases,as well as on the trunk in 10 cases.Before surgery,the composition of tumescent solution was adjusted according to the body weight,operation duration,skin lesion area,etc.,and the total dose and peak plasma concentration of lidocaine should be below 35 mg/kg and 4 mg/L respectively.All the patients received tissue expander placement and second-stage flap transfer under tumescent anesthesia.Results During surgery,satisfactory effect of tumescent anesthesia was achieved in all the 41 patients,the pain score assessed by a numerical rating scale was 1.82±0.54.In addition,the surgical field and dissection levels were clear with little bleeding and no related complications.Follow-up of 3-36 months showed that the skin flaps matched the surrounding skin tissues well,with relatively concealed incision lines and soft flat scars.Conclusion For the treatment of congenital giant melanocytic nevi,tumescent anesthesia is effective and safe,which combined with skin and soft tissue expansion can effectively reduce the incidence of postoperative complications,and this strategy is worthy of clinical promotion.

关 键 词：麻醉 扩张术 痣 肿胀麻醉 皮肤软组织扩张术 先天性巨痣 

分 类 号：R614[医药卫生—麻醉学]