小切口包膜内剥离浅表及肌间脂肪瘤的并发症及复发率分析  

Complications and recurrence rate of subcutaneous and intramuscular lipoma resection with small incision and reserved capsule

作　　者：林文韬 张杰[2] 申霄[1] 贺光照[1] LIN Wen-tao;ZHANG Jie;SHEN Xiao;HE Guang-zhao(Department of Plastic Surgery,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院医疗美容科,重庆400016 [2]重庆医科大学附属第一医院肿瘤科,重庆400016

出　　处：《临床皮肤科杂志》2022年第5期303-308,共6页Journal of Clinical Dermatology

摘　　要：目的:比较小切口与传统切口对浅表及肌间脂肪瘤切除术后早期并发症及远期复发率的影响。方法:根据切口长度分组,传统切口组为切口≤留体长轴,采用包膜外切除瘤体;小切口组为切口约为瘤体长轴的14-1/3,若有包膜者,采用包膜内剥离瘤体。其中浅表脂肪瘤传统切口组49例,小切口组59例;肌间脂肪瘤传统切口组30例,小切口组23例。分别对比术后感染、血肿、血清肿、切口愈合、癜痕等并发症及复发率的差异。结果:92.6%浅表脂肪瘤含有包膜,45.3%肌间脂肪瘤含有包膜,浅表脂肪瘤与肌间脂肪瘤包膜出现率比较差异有统计学意义(P<0.05)。浅表脂肪瘤2组患者术后早期并发症发生率瘢痕美容评估与评级量表、瘢痕满意度比较差异均有统计学意义(P<0.05);小切口组术后早期并发症发生率更低,瘢痕评估及瘢痕满意度更高;2组复发率比较差异无统计学意义(P>0.05)。肌间脂肪瘤2组术后早期并发症发生率及远期复发率比较差异无统计学意义(P>0.05);2组瘢痕美容评估与评级量表瘢痕满意度比较,差异均有统计学意义(P<0.05),且小切口组瘢痕评估及瘢痕满意度更高。结论:保留包膜不影响术后复发率;浅层肌肉深面或肌间隙内形态规则包膜完整的肌间脂肪瘤推荐采用小切口的术式可以有效改善术后的搬痕。浅表脂肪瘤推荐采用小切口包膜内切除,可以有效改善术后的搬痕,降低术后的并发症,安全有效.值得临床推广应用。Objective:To compare the effect of small incision and traditional incision on postoperative complications and recurrence rate of subcutaneous and intramuscular lipoma resection.Methods:The patients were divided into two groups according to the incision.In the traditional incision group,the incision was slightly equal to the long axis of the lipoma,and the lipoma was resected from outside of the capsula In the small incision group,the incision was at about 1/4-1/3 of the long axis of the lipoma,and it was resected from inside of the capsule.Forty-nine subcutaneous lipomas were in the traditional incision group and 59 in the small incision group.Thirty intramuscular lipomas were in the traditional group and 23 in the small incision group.The postoperative complications and recurrence rates in two groups were compared.Results:The capsule occurrence rate was 92.6%in the subcutaneous lipoma group and 453%in the intramuscular lipoma group.There were significant differences(P<0.05)in postoperative complication rates,the score of the scar cosmesis assessment and rating(SCAR)scale,and satisfaction of the scar formation between the two subcutaneous lipoma groups.The SCAR score and satisfaction were higher and the postoperative complication rates were lower in the small incision group.There were significant differences(P<0.05)in SCAR score and satisfaction between the two intramuscular lipoma groups.The SCAR score and satisfaction were higher in the small incision group.There was no significant diflerence(P>0.05)in the postoperative complication rates between the two intramuscular lipoma groups.There was no significant difierence(P>0.05)in the recurrence rate among the groups.Conclusion:Preserving capsule has no effect on the recurrence rate.Small incisions are recommended for intramuscular lipoma with regular shape and intact capsule under the superficial muscle or intermuscular space to reduce scar formation.The intracapsular resection of the subcutaneous lipoma with small incision can improve postoperative scar formation

关 键 词：|脂肪瘤 外科手术 手术后并发症 瘢痕 包膜 复发 

分 类 号：R751[医药卫生—皮肤病学与性病学]