臀部双侧V-Y推进岛状皮瓣修复肛周Paget病术后缺损的应用  

Application of bilateral V-Y advancement island flaps on buttocks in repair of postoperative defects in patients with perianal Paget′s disease

作　　者：岳超 王涛[1] 段梦莹 戴叶芹[1] 彭建中[1] 沈忠[2] 宋秀祖[1] Yue Chao;Wang Tao;Duan Mengying;Dai Yeqin;Peng Jianzhong;Shen Zhong;Song Xiuzu(Department of Dermatology,Hangzhou Third People′s Hospital,Hangzhou 310009,China;Department of Proctology,Hangzhou Third People′s Hospital,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院皮肤科,杭州310009 [2]杭州市第三人民医院肛肠科,杭州310009

出　　处：《中华皮肤科杂志》2024年第1期58-61,共4页Chinese Journal of Dermatology

摘　　要：目的 探讨臀部双侧V-Y推进岛状皮瓣修复肛周Paget病术后继发肛周缺损的临床效果.方法 回顾性分析2009年1月至2021年1月期间杭州市第三人民医院皮肤科13例肛周Paget病患者在肿瘤切净后采用臀部双侧V-Y推进岛状皮瓣修复肛周缺损的临床资料,总结术后臀部恢复情况以及对肛门排便功能的影响.结果 13例肛周缺损面积4.8 cm × 5.6 cm~12.2 cm × 16.4 cm,采用臀部双侧V-Y推进岛状皮瓣修复缺损,全部一期愈合.1例行临时性回肠造口术,3个月后行回肠造口回纳术后,肛门排便功能恢复;1例合并直肠癌,行乙状结肠永久性造口术分流粪便,肛门排便功能丧失.随访1~6年,13例患者臀部形态对称,12例肛门保留者排便功能正常.未合并其他恶性肿瘤的12例肛周Paget患者术后肿瘤无复发,3例患者出现肛门轻度狭窄,无肛门黏膜外翻,无伤口裂开;1例合并肛管腺癌的肛周Paget病患者在术后1年出现双侧腹股沟淋巴结、髂内淋巴结转移,半年后死亡.结论 臀部双侧V-Y推进岛状皮瓣血供可靠,推进幅度大,可修复肛周较大面积的皮肤缺损.Objective To investigate the clinical efficacy of bilateral V-Y advancement island flaps on buttocks in repairing postoperative defects in patients with perianal Paget's disease.Methods From January 2009 to January 2021,a retrospective analysis was performed on clinical data collected from 13 patients with perianal Paget's disease,whose perianal defects resulting from the tumor resection were reconstructed with bilateral V-Y advancement island flaps on the buttocks in the Department of Dermatology,Hangzhou Third People's Hospital.The postoperative recovery of the buttocks and the effects on the defecation function were evaluated.Results The areas of perianal defects in 13 cases ranged from 4.8 cm×5.6 cm to 12.2 cm×6.4 cm.All defects were successfully repaired by using the bilateral V-Y advancement island flaps,and all surgical wounds healed primarily.One case first received temporary ileostomy,and then received ileostomy closure 3 months later,resulting in the recovery of defecation function;in another 1 case of perianal Paget's disease comorbid with rectal cancer,the permanent sigmoid colostomy was performed to divert feces,and the defecation function was lost.After the follow-up for 1-6 years,the buttocks were symmetrical in shape in all the 13 patients,and 12 with preserved anus had normal defecation function.No tumor recurrence was observed in 12 patients without other malignant tumors after the operation,while 3 patients experienced mild anal stenosis without anal mucosa eversion or wound dehiscence;1 patient with perianal Paget's disease complicated by anal canal adenocarcinoma developed bilateral inguinal lymph node and internal iliac lymph node metastasis 1 year after the operation,and died 6 months later.Conclusion The bilateral V-Y advancement island flaps on the buttocks have the advantages of reliable blood supply and sufficient advancement mobility,and can be used to repair large skin defects around the anus.

关 键 词：佩吉特病 乳腺外 肛周缺损 岛状皮瓣 V-Y推进 修复 

分 类 号：R657.1[医药卫生—外科学]