巨大神经纤维瘤的治疗经验  

Experience in the treatment of giant neurofibromas

作　　者：夏明 吴为民 温立霞 郑华蓉 向婷婷 Xia Ming;Wu Weimin;Wen Lixia;Zheng Huarong;Xiang Tingting(Department of Burn and Plastic Surgery,the First College of Clinical Medical Science,China Three Gorges University,Yichang Central People’s Hospital,Yichang 443000,China)

机构地区：[1]三峡大学第一临床医学院、宜昌市中心人民医院烧伤整形外科,宜昌443000

出　　处：《中华整形外科杂志》2023年第9期990-995,共6页Chinese Journal of Plastic Surgery

基　　金：宜昌市中心人民医院伦理委员会批准(申PJ2023-08)。

摘　　要：目的总结巨大神经纤维瘤的治疗经验。方法回顾性分析2019年1月至2022年12月宜昌市中心人民医院烧伤整形外科收治的巨大神经纤维瘤患者的临床资料。术前通过介入技术完成瘤体营养血管栓塞术,术中边剥离瘤体边进行止血,从瘤体基底部将其完整切除,针对不同的创面分别行创缘直接拉拢缝合,或于瘤体表面取全厚皮肤制成网状皮片原位回植修复创面,并以负压封闭引流敷料覆盖创面,负压维持在-150~-250 mmHg(1 mmHg=0.133 kPa)。术后对瘤体复发、缺损修复及相关并发症发生情况进行观察和随访。结果共纳入4例患者,男2例,女2例,年龄43~56岁,平均49.3岁,其中有2例曾在外院行神经纤维瘤切除术。4例患者肿瘤分别位于左股部、臀部、左腰部、左小腿,体积分别为20 cm×10 cm×10 cm、50 cm×20 cm×15 cm、20 cm×15 cm×10 cm、15 cm×10 cm×8 cm。左股部及左小腿瘤体切除后直接将创缘拉拢缝合,臀部及左腰部取瘤体表面全厚皮肤制成网状皮片回植。术后1例臀部神经纤维瘤患者由于创面失血过多转入重症医学科治疗,之后创面形成窦道,经多次换药后创面愈合;其余3例均于术后2周拆除负压封闭引流敷料及伤口缝线,创面愈合良好。术后随访6个月至3年,4例患者创面均愈合良好,未见肿瘤复发,无运动及感觉功能障碍。结论采用手术切除及整形外科技术治疗巨大神经纤维瘤可获得较好的效果。术前行瘤体栓塞治疗,术中完整剥离肿物,可有效降低出血的风险;肿瘤切除后遗留的较小创面可直接缝合,较大创面可制备肿瘤表面网状皮片回植;负压封闭引流可促进创面愈合。Objective To summarize the experience in the treatment of giant neurofibromas.Methods A retrospective analysis was performed on the clinical information of patients with giant neurofibromas who were admitted to the Department of Burn and Plastic Surgery,Yichang Central People’s Hospital from January 2019 to December 2022.Preoperative endovascular embolization was performed by interventional technique.Intraoperatively,the tumor was stripped while hemostasis was performed,and the tumor was completely removed radically.Depending on the type of wound,the wound was closed directly,or with the meshed full-thickness skin taken from the surface of the tumor.The vacuum sealing drainage dressing with a stable suction pressure of-150--250 mmHg(1 mmHg=0.133 kPa)was used.Then tumor recurrence,defect repair,and associated complications were observed and followed up.Results A total of 4 patients were included,2 males and 2 females,aged 43-56 years with an average age of 49.3 years.Two patients had previous resection surgery at other hospitals.The tumors in the four patients were situated in the left thigh,buttocks,left waist and left leg respectively,with volumes of 20 cm×10 cm×10 cm,50 cm×20 cm×15 cm,20 cm×15 cm×10 cm and 15 cm×10 cm×8 cm correspondingly.After resection of the tumor from the left thigh and leg,the wounds were closed directly.The mesh skin graft from the tumor on the buttock and left waist was used for wound after tumor resection.Following the surgery,the patient with a neurofibroma on the buttock was transferred to the intensive care unit due to excessive blood loss.The sinus tract was formed,but healed after several dressing changes.The vacuum sealing dressing and sutures were removed two weeks after the operation for other cases.The wounds healed well and during the six months to three years follow-up,no tumor recurrence,impairment of motor or sensory function was found.Conclusion Surgical resection and plastic surgery techniques are effective in treating giant neurofibromas.Preoperative tumor embo

关 键 词：神经纤维瘤 修复外科手术 栓塞 治疗性 皮肤移植 负压封闭引流 

分 类 号：R739.4[医药卫生—肿瘤]