14例头面部瘢痕癌溃疡创面的临床诊疗分析  

Clinical diagnosis and treatment of 14 cases of scar cancer ulcer wound on head and face

作　　者：陈新冲 黄广涛 CHEN Xinchong;HUANG Guangtao(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563000,P.R.China;Department of Burn and Plastic Surgery,the First Affiliated Hospital of Shenzhen University(Shenzhen Second People’s Hospital),Shenzhen Guangdong,518000,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563000 [2]深圳大学第一附属医院(深圳市第二人民医院)烧伤整形外科,广东深圳518000

出　　处：《中国修复重建外科杂志》2024年第3期342-347,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82172238、81960353)。

摘　　要：目的分析头面部瘢痕癌溃疡创面的临床特点,探讨其诊治方法。方法回顾性分析2021年1月—2022年3月收治且符合选择标准的14例头面部瘢痕癌溃疡创面患者临床资料。男8例,女6例;发病年龄21~81岁,平均61.6岁。潜伏期1个月~70年,中位时间4年。发病部位:头顶部7例、颌面部6例、颈部1例。致伤因素:创伤5例,抓伤5例,烫伤2例,烧伤1例,针刺伤1例。病理检查结果示鳞状细胞癌9例、基底细胞癌3例、皮脂腺癌1例、乳头状汗管囊腺瘤合并管状顶泌汗腺腺瘤1例。手术行单纯肿瘤扩大切除1例,肿瘤扩大切除+植皮修复1例,肿瘤扩大切除+局部皮瓣转移修复7例,肿瘤扩大切除+游离皮瓣移植修复5例。结果14例患者均获随访,随访时间16~33个月,平均27.8个月。2例(14.29%)患者出现瘢痕癌溃疡创面复发,其中1例术后化疗2个疗程,于术后2年复发,现予以口服中药治疗,仍健在;1例于术后1年复发,复发后化疗2个疗程,已死亡。1例患者行左眼及眼周肿瘤扩大切除+游离左侧旋股外侧动脉降支穿支嵌合肌肉轴型皮瓣转移修复术,术后切口愈合不良,经抗感染和扩创缝合术处理后愈合良好;其余患者瘢痕癌溃疡创面均未复发,创面愈合良好。结论头面部瘢痕癌常见于中老年男性人群,主要病理类型是鳞状细胞癌;局部扩大切除、植皮或皮瓣修复是主要治疗方法。早期积极处理各种损伤后的创面,避免瘢痕反复破溃、感染是预防瘢痕癌变的根本。Objective To analyze the clinical characteristics of scar cancer ulcer wound of head and face,and to investigate its diagnosis and treatment.Methods The clinical data of 14 patients with head and facial scar cancer ulcer wounds who met the selection criteria admitted between January 2021 and March 2022 were retrospectively analyzed.There were 8 males and 6 females.The age of onset ranged from 21 to 81 years with an average age of 61.6 years.The incubation period ranges from 1 month to 70 years,with a median of 4 years.Site of the disease included 7 cases of head,6 cases of maxillofacial region,and 1 case of neck region.Injury factors included trauma in 5 cases,scratch in 5 cases,burn in 2 cases,scalding in 1 case,and needle puncture in 1 case.Pathological results showed squamous cell carcinoma in 9 cases,basal cell carcinoma in 3 cases,sebaceous adenocarcinoma in 1 case,papillary sweat duct cystadenoma combined with tubular apocrine sweat gland adenoma in 1 case.There were 1 case of simple extensive tumor resection,1 case of extensive tumor resection and skin grafting repair,7 cases of extensive tumor resection and local flap transfer repair,and 5 cases of extensive tumor resection and free flap transfer repair.Results All the 14 patients were followed up 16-33 months(mean,27.8 months).Two patients(14.29%)had scar cancer ulcer wound recurrence,of which 1 patient recurred at 2 years after 2 courses of postoperative chemotherapy,and was still alive after oral traditional Chinese medicine treatment.One patient relapsed at 1 year after operation and died after 2 courses of chemotherapy.One patient underwent extensive resection of the left eye and periocular tumor and the transfer and repair of the chimaeric muscle axial flap with the perforating branch of the descending branch of the left lateral circumflex femoral artery,but the incision healing was poor after operation,and healed well after anti-infection and debridement suture.The wound of other patients with scar cancer ulcer did not recur,and the wound healed we

关 键 词：瘢痕癌 溃疡创面 皮瓣修复 

分 类 号：R739.5[医药卫生—肿瘤]