218例成人甲母痣手术治疗策略  

Surgical treatment strategy of 218 adult patients clinically diagnosed with nevus of the nail matrix

作　　者：郝军峰 赵涛 郭伟楠 马翠玲 高天文 赵建红 李冰 HAO Junfeng;ZHAO Tao;GUO Weinan;MA Cuiling;GAO Tianwen;ZHAO Jianhong;LI Bing(Department of Dermatology,Xijing Hospital,The Fourth Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学西京皮肤医院,陕西西安710032

出　　处：《临床皮肤科杂志》2025年第2期74-77,共4页Journal of Clinical Dermatology

基　　金：国家自然科学基金资助项目(82103732)。

摘　　要：目的:探讨成人甲母痣的手术治疗策略。方法:收集218例临床诊断为成人甲母痣的患者的临床资料,以甲板色素斑条带宽度3 mm为界分成两组,分别选择不同的手术方式,并进行术后皮损组织病理检查及长期密切随访。结果:122例条带宽度≤3 mm的甲正中甲母痣患者中,除18例患者出现甲板纵裂及近端甲皱襞胬肉等并发症外,其余患者均恢复良好。49例条带宽度≤3 mm的甲侧缘甲母痣患者中,除3例失访,其余均恢复良好。47例条带宽度>3 mm的患者中,除9例术区出现残甲、表皮样囊肿及植皮区黑斑及2例失访外,其余患者均恢复良好。术后组织病理检查显示,171例条带宽度≤3 mm的患者组中有20例(11.7%)为甲黑素瘤,47例>3 mm患者组中有25例(53.2%)为甲黑素瘤。结论:临床诊断的成人甲母痣,当条带宽度≤3 mm时选择条带边缘扩大1~2 mm切除后直接拉拢缝合为宜,宽度>3 mm时选择甲单位外围扩大5 mm切除后植皮为宜。Objective:To explore the surgical strategy of adult patients clinically diagnosed with nevus of the nail matrix.Methods:A total of 218 patients who were clinically diagnosed with nevus of the nail matrix were categorized into two groups:group 1 with the band width>3 mm and group 2 with the band width≤3 mm.The patients from two different groups underwent different surgical interventions,and histopathological examination and their prognosis were closely monitored.Results:Among the 122 patients with band width≤3 mm and band located in the middle of nail,apart from 18 complications of nail splitting and pterygium,the rest of the patients recovered well.Among the 49 patients with band width≤3 mm and band located in the edge of nail,apart from 3 cases who were lost to follow-up,the rest of the patients recovered well.Among the 47 patients with band width>3 mm and band located in the edge of nail,apart from 2 cases who were lost to follow-up and 9 cases with complications of residual nail,epidermoid cyst and hyperpigmentation of the grafted skin,the rest recovered well.The histopathological examination after surgical removal showed that among the 171 patients in the group with band width≤3 mm,20 cases were histologically diagnosed with subungual melanoma,whereas in the group with band width>3 mm(47 patients),25 cases were histologically diagnosed with subungual melanoma.Conclusion:Those clinically diagnosed adult nevus of the nail matrix with bands width≤3 mm are preferred to expand the boundary of 1~2 mm and choose direct suture after resection,while for those with band width>3 mm are preferred to expand the boundary of 5 mm after nail unit resection,followed by skin grafting.

关 键 词：成人 甲母痣 手术 策略 

分 类 号：R758.72[医药卫生—皮肤病学与性病学]