不同部位烧伤瘢痕癌的外科治疗策略  

Surgical treatment strategies for Marjolin's ulcer in different locations:a retrospective analysis of 38 cases

作　　者：赵筱卓 沈余明 ZHAO Xiaozhuo;SHEN Yuming(Burn Department of Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院烧伤科,北京100035

出　　处：《中国现代手术学杂志》2024年第2期120-127,共8页Chinese Journal of Modern Operative Surgery

基　　金：国家重点研发计划功能组织与器官体外精准制造技术与重建项目(2018YFA0703104);国家重点研发计划“诊疗装备与生物医学材料”重点专项(2022YFC2403004)。

摘　　要：目的探讨不同部位烧伤瘢痕癌的创面修复策略。方法回顾性分析我科2013年1月至2023年1月收治的38例烧伤瘢痕癌患者的临床资料,总结临床特点、影像学、病理学诊断评估和手术方法,观察创面愈合情况、肿瘤复发率和存活率。结果38例患者中,男23例,女15例,平均年龄(53.63±9.74)岁,其中火焰烧伤32例,热水烫伤6例,癌变潜伏期(35.65±14.60)年。病变位于头部7例、下肢18例、上肢8例、躯干3例、面部2例。2例为基底细胞癌(浅表型1例,浸润型1例,病理分级:中分化1例,高分化1例),36例为鳞状细胞癌(病理分级:低分化2例,中分化10例,高分化24例)。35例患者接受手术治疗,其中6例截肢;另3例放弃治疗。创面修复方案包括植皮手术19例、局部皮瓣4例和游离皮瓣转移6例。中位随访时间2(2,3)年,3例放弃治疗的患者在随访期间死亡,余35例手术的患者中30例创面愈合良好且肿瘤未复发,5例肿瘤复发(3例再次接受手术治疗,死亡1例,存活2例;2例保守治疗,死亡1例,存活1例)。结论针对烧伤瘢痕癌的创面修复策略应根据肿瘤部位、性质、范围和患者全身条件进行个性化制定,早期切除病变是治疗的关键。植皮、皮瓣转移、游离皮瓣移植和截肢等方法可用于修复烧伤瘢痕癌的创面。手术治疗能够促进创面的愈合,但肿瘤复发仍然是一个重要的问题,需要进一步研究和探索。Objective To explore wound repair strategies for Marjolin's ulcer.Methods A retrospective analysis was conducted on the clinical data of 38 patients with Marjolin's ulcer who were treated in our department over the past 10 years.Clinical data analysis,radiopathological diagnosis evaluation,and description of surgical methods were performed.Outcome measures included surgical approaches,wound healing status,tumor recurrence,and survival rate.Results Among the 38 patients,there were 23 males and 15 females,with a mean age of(53.63±9.74)years.The causes of the burns were flame burns in 32 cases and scald burns in 6 cases,with a mean latent period of(35.65±14.60)years.The lesions were located in the head(7 cases),lower limbs(18 cases),upper limbs(8 cases),trunk(3 cases),and face(2 cases).Pathological examination revealed 2 cases of basal cell carcinoma(superficial phenotype 1 case,infiltrating type 1 case;pathological grading:moderately differentiated 1 case,and highly differentiated 1 case)and 36 cases of squamous cell carcinoma(pathological grading:poorly differentiated 2 cases,moderately differentiated 10 cases,and highly differentiated 24 cases).Among them,35 patients underwent surgical treatment,with 6 patients undergoing amputation.Wound repair strategies included skin grafting(19 cases),local flaps(4 cases),and free flap transfer(6 cases).The median follow-up time was 2(2,3)years.30 patients had good wound healing without tumor recurrence,while 5 patients experienced tumor recurrence,with 3 undergoing subsequent surgical treatment.One patient died during the follow-up period,and 3 patients opted out of treatment and died during the follow-up period.Conclusion Wound repair strategies for Marjolin's ulcer should be personalized based on the tumor's location,nature,extent,and the overall condition of the patient,with early excision of the lesion being the key to treatment.Methods such as skin grafting,flap transfer,free flap transplantation,and amputa-tion can be used to repair the wound caused by Marjolin's ulc

关 键 词：烧伤瘢痕癌 Marjolin溃疡 烧伤瘢痕 瘢痕溃疡 鳞状细胞癌 皮肤肿瘤 创面修复 

分 类 号：R644[医药卫生—外科学]