先天性巨大黑色素细胞痣早期治疗的可行性探讨  

Feasibility of early treatment of congenital giant melanocytic nevus

作　　者：张佳琦[1] 陈程[1] 石芬 苏正[1] 肖小莲 张剑 陈宸 王永振 梁伟强[1] 张金明[1] Zhang Jiaqi;Chen Cheng;Shi Fen;Su Zheng;Xiao Xiaolian;Zhang Jian;Chen Chen;Wang Yongzhen;Liang Weiqiang;Zhang Jinming(Department of Plastic Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China)

机构地区：[1]中山大学孙逸仙纪念医院整形外科,广州510000

出　　处：《中华整形外科杂志》2022年第11期1203-1209,共7页Chinese Journal of Plastic Surgery

基　　金：广东省医学科学技术研究基金项目(A2022532)。

摘　　要：目的探讨早期治疗先天性巨大黑色素细胞痣(巨痣)的可行性。方法回顾性分析2013年10月至2021年12月, 在孙逸仙纪念医院整形外科应用皮肤软组织扩张术治疗巨痣的患儿临床资料。一期埋置肾形扩张器, 手术方式包括单次扩张和重复扩张。二期手术切除巨痣, 行扩张皮瓣转移修复术。随访观察并发症发生情况、患儿的心理健康问题和患儿家长满意度。采用χ2检验比较不同年龄组的组间并发症的发生率以及内置型和外置型扩张器感染率。结果共纳入58例患儿, 男24例, 女34例, 年龄为3个月至3岁, 平均(1.45±0.83)岁。共埋置190个扩张器, 术后随访5~106个月, 平均42.43个月, 扩张器埋置期间发生扩张器伤口感染29个, 扩张器外露41个, 扩张皮瓣血供障碍2个, 扩张器破裂6个, 对症处理后均未影响二期皮瓣转移。3个月~<1岁、1~<2岁、2~<3岁及3岁年龄组之间并发症发生率的分别为37.34%(31/83)、56.75%(21/37)、3.33%(13/39)及41.94%(13/31), 组间比较差异无统计学意义(χ^(2)=5.21, P=0.157), 内置型和外置型扩张器注水壶伤口感染发生率分别为16.67%(6/36)和14.94%(23/154), 两者比较差异亦无统计学意义(χ^(2)=0.07, P=0.795)。所有患儿外形得到了显著改善, 效果良好, 患儿家长满意度评价:39例患儿家长为特别满意, 20例为一般, 未发现患儿出现心理健康问题。结论皮肤软组织扩张术是早期治疗先天性巨痣较为可靠的方法。Objective To investigate the feasibility of early treatment of congenital giant melanocytic nevus(CGMN).Methods From October 2013 to December 2021,the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively.A renal expander was implanted in the first stage,including single and repeated expansion.The giant nevus was removed and repaired in the second stage with an expanded skin flap.The occurrence of complications,such as wound infection,expander exposure,expander rupture,and flap congestion,were recorded.Children’s mental health problems and their parents’satisfaction were also analyzed.Theχ2 between children of different ages and the infection rate between children with an internal and external pot.Results A total of 58 children,24 males and 34 females,aged from 3 months to 3 years,with an average age of 1.45 years,were enrolled.A total of 190 expanders were implanted.The patients were followed for 5 to 106 months,averaging 42.43 months.In the first stage,29 cases of wound infection,41 cases of expander exposure,two cases of flap congestion,and 6 cases of expander rupture occurred.The flap transfers were not affected by these complications after appropriate treatment.The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75%((21/37)),33.33%(13/39)and 41.94%(13/31),respectively,No statistically significant difference(χ^(2)=5.21,P=0.157).The incidence of wound infection was 16.67%(6/36)and 14.94%(23/154),respectively,for the internal and external dilators.There was no significant difference in the location of the dilator pot and the incidence of wound infection(χ^(2)=0.07,P=0.795).The appearance of all children has been significantly improved.Thirty-nine children’s families are particularly satisfied,and 20 are generally satisfied with the treatment effect,and no mental health problems were found.Conclusions Skin and sof

关 键 词：组织扩张术 痣 色素 整形手术 外科皮瓣 手术后并发症 先天性黑色素细胞痣综合征 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]