儿童头皮先天性巨痣1例及文献复习  

Surgical therapy of giant nevus of scalp in children:one case report with a literature review

作　　者：王安娜 林枫 郝春雨 周美玲 王洪一 Wang Anna;Lin Feng;Hao Chunyu;Zhou Meiling;Wang Hongyi(Department of Burn&Plastic Surgery,General Hospital,North Theater Command of PLA,Shenyang 110016,China)

机构地区：[1]中国人民解放军北部战区总医院烧伤整形科,沈阳110016

出　　处：《中华小儿外科杂志》2024年第10期891-895,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金青年科学基金项目(82002047)。

摘　　要：目的总结儿童头皮先天性巨痣的手术治疗经验。方法回顾性分析1例2022年3月在中国人民解放军北部战区总医院接受手术治疗的头皮先天性巨痣的患儿临床资料。患儿,女,5岁4个月,因"头顶部肿物缓慢增大5年"就诊,患儿头皮肿物面积约为28 cm×21 cm,手术切除患儿头皮肿物,并取患儿正常头皮及右大腿薄成皮片对创面行植皮修复。以"头皮巨痣""头皮先天性巨痣""头皮先天性黑色素细胞痣"及其英文"giant nevus of scalp""giant congenital nevus of scalp""giant congenital melanocytic nevus of scalp"为关键词,检索截至2022年11月PubMed、Ovid数据库、Cochrane协作网、万方、中国知网、维普及中国生物医学文献数据库中关于低龄(≤8岁)儿童先天性巨痣手术的相关文献并行文献复习。结果本例患儿手术在3 h内顺利完成,术中失血量约100 ml,术后失血量约为486 ml。病理结果显示切除肿物为头皮巨痣伴结缔组织增生。术后3个月患儿头部植皮成活,术后2年外观形态满意。文献检索到8篇42例≤8岁的患儿接受巨痣切除手术,其中2例采用植皮术修复,其余40例采用扩张器法修复,修复方法主要根据患儿肿物面积大小选择。结论儿童巨痣切除手术应根据患儿头部肿物面积及供血情况选择合适的修复方式,术前术中应做好失血量评估,手术步骤应围绕失血控制进行。Objective To summarize the surgical experiences of treating congenital giant nevi of scalp in children.Methods Retrospective analysis was performed for the relevant clinical data of a 64-month-old girl operated for congenital giant nevus of scalp in March 2022.One slowly enlarging mass appeared on the top of head for five years with a lesion area of approximately 28 cm×21 cm on scalp.Surgical excision of scalp mass was performed.And skin grafting was performed with normal scalp tissue and thin skin grafts from right thigh for repairing wounds.A literature review was conducted by searching the databases of PubMed,Ovid,Cochrane Library,Wanfang,China National Knowledge Infrastructure(CNKI),VIP and SinoMed up to November 2022 using such key words as"giant nevus of scalp,""giant congenital nevus of scalp,""giant congenital melanocytic nevus of scalp"and their English equivalents.The searches focused upon surgical interventions for congenital giant nevi in young children aged≤8 year.Results Surgery was successfully completed within 3h with an intraoperative blood loss of 100 ml and a postoperative blood loss of 486 ml.Pathological examination hinted at giant nevus of scalp with connective tissue hyperplasia.At Month 3 postoperatively,skin graft on head survived and cosmetic outcomes were satisfactory 2 years after surgery.The literature search yielded 8 articles involving 42 children aged≤8 years undergoing giant nevus excision.The repairing modes were skin grafting(n=2)and using tissue expanders(n=40).Selecting repair modes was based primarily upon lesion size.Conclusions Selecting appropriate repair modes for giant nevus excision in children should be based upon size of head lesion and blood supply.Perioperative blood loss assessment is crucial and surgical procedures should focus upon controlling blood loss.

关 键 词：痣 色素 植皮术 失血 儿童 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]