儿童甲母痣35例外科治疗效果分析  

Efficacy of surgical treatment for 35 children with nail matrix nevi

作　　者：刘燕[1] 邱林 傅跃先[1] 田晓菲[1] 袁心刚[1] 肖军[1] 李天武[1] 毛小波[1] 梅爱莲 郭永强 周荣 Liu Yan;Qiu Lin;Fu Yuexian;Tian Xiaofei;Yuan Xingang;Xiao Jun;Li Tianwu;Mao Xiaobo;Mei Ailian;Guo Yongqiang;Zhou Rong(Department of Burns and Plastic surgery,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院烧伤整形科儿童发育疾病研究教育部重点实验室国家儿童健康与疾病临床医学研究中心儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,重庆400014

出　　处：《中华皮肤科杂志》2022年第5期430-433,共4页Chinese Journal of Dermatology

摘　　要：目的探讨儿童甲母痣外科手术治疗的合理术式。方法回顾分析重庆医科大学附属儿童医院2015年9月至2019年3月手术治疗的35例甲母痣(病理确诊)患儿的临床资料,根据病变部位、宽度采取不同的手术方式。对病变宽度≤3 mm者,采用甲床及甲母质病变外缘旁开1~2 mm直接切除缝合术治疗,共11例。对病变宽度>3 mm者,由患儿家长在以下3种术式中选择1种进行治疗:①甲床及甲母质病变8倍显微镜下削除术,共8例;②病变切除联合指(趾)骨骨膜上全厚植皮术,共8例;③病变切除联合鱼际肌区皮瓣转移和全厚植皮术(2~5指病变),共5例,或病变切除联合腹壁皮瓣转移术,共3例。术后随访12个月并评估临床疗效。结果11例直接切除缝合治疗的病例术后无复发,外观好,甲上遗留纵向瘢痕线。8例显微镜下削除治疗的病例术后6~12个月复发4例,未复发病例指(趾)甲外观凹凸不平且光泽度差。病变切除联合全厚植皮治疗的8例术后无复发,1例植皮坏死,7例植皮完全存活伴明显色素沉着。病变切除联合鱼际肌区皮瓣转移及腹壁皮瓣转移治疗的病例术后无复发,转移皮瓣全部存活,鱼际肌区皮瓣转移术后外观好,皮肤色泽接近正常甲色泽,腹壁皮瓣转移术后皮肤色泽与正常甲差异较大。结论对于甲母痣,当病变宽度≤3 mm时建议采用病变外缘旁开1~2 mm直接切除缝合术治疗,>3 mm时建议病变切除联合全厚植皮或病变切除联合鱼际肌区皮瓣转移或腹壁皮瓣转移术治疗;显微镜下病变削除术需慎重使用。Objective To explore rational surgical treatment for childhood nail matrix nevi.Methods A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi,who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019.Different surgical approaches were adopted according to the site and width of lesions.For lesions with a width of≤3 mm,the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases.For lesions with a width of>3 mm,one of the following 3 surgical procedures was selected by the children′s parents:(1)shaving of nail bed and nail matrix lesions under a microscope at×8 magnification(8 cases);(2)excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx(8 cases);(3)excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting(5 cases),or excision of lesions of the thumb followed by abdominal-wall flap transfer(3 cases).The patients were followed up for 12 months,and clinical efficacy was evaluated.Results During the follow-up,no recurrence occurred in the 11 cases receiving direct excision and suture,with good appearances and longitudinal linear scars on the nail.Among the 8 cases receiving shaving therapy under a microscope,4 experienced relapse during the follow-up of 6-12 months,and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence.No recurrence was observed in the 8 cases after excision of the lesions and full-thickness skin grafting,of whom 1 experienced skin graft necrosis,and skin grafts survived with obvious pigmentation in the other 7 cases.Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer,no recurrence was observed,and all transferred flaps survived;good appearances,nearly normal colo

关 键 词：痣 色素 指(趾)甲疾病 儿童 外科手术 甲母痣 

分 类 号：R758.72[医药卫生—皮肤病学与性病学]