摘要
目的总结不同手术方法修复与重建头皮恶性肿瘤术后缺损,评价其临床效果。方法1995年1月-2004年9月,对70例头皮恶性肿瘤患者行手术治疗,其中男41例,女29例;年龄30～85岁,平均50.3岁。病程2周～3年,平均3.5个月。基底细胞癌31例,鳞状细胞癌24例,恶性黑色素瘤8例,纤维肉瘤4例,脂肪肉瘤2例,血管肉瘤1例。病变范围1.0cm×0.5cm～10.0cm×8.0cm。根治性切除肿瘤后缺损3cm×3cm～12cm×11cm,采用中厚皮片移植51例,邻近头皮瓣移位12例,颈肩随意皮瓣移位2例,斜方肌肌皮瓣移位3例,桡动脉逆行岛状皮瓣2例,切取范围5cm×4cm～18cm×12cm。结果67例皮片及皮瓣成活,伤口Ⅰ期愈合;2例皮瓣远端坏死,经过换药后Ⅱ期愈合;1例桡动脉逆行岛状皮瓣感染,对症处理后愈合。供区均Ⅰ期愈合。55例患者获随访1～5年,5例复发。植皮患者中鳞状细胞癌患者和纤维肉瘤患者各1例,分别于术后1年及2年半复发,均再次行根治性切除后采用皮瓣移位修复创面;皮瓣移位患者中血管肉瘤患者及鳞状细胞癌患者各1例于术后6个月及3个月复发放弃治疗,1例纤维肉瘤患者术后2年复发,再次根治性切除后采用皮瓣移位修复创面。余患者均存活良好。结论头皮恶性肿瘤应早期诊断、及时治疗,广泛彻底切除并进行合理的创面修复是有效的治疗方法。
Objective To investigate the effects of different surgical methods in treating scalp malignant tumors. Methods From January 1995 to September 2004, 70 patients with scalp malignant tumor were treated with different surgical methods. There were 41 males and 29 females withan average age of 50.3 years （30-85 years）. The course of disease ranged from 2 weeks to 3 years（mean 3.5 months）. There were 31 cases of basal cell carcinoma, 24 cases of squamous carcinoma, 8 cases of melanocarcinoma, 4 cases of fibrous sarcoma, 2 cases of liposarcoma, and 1 case of vasculosarcoma. Leision size ranged from 1.0 cm × 0.5 cmto 10.0 cm × 8.0 cm. Scalp defect ranged from3 cm × 3 cm to 12 cm× 11 cm after clearing up the tumors. Defect was repaired with free skin transplantation in 51 cases, scalp flap in 12 cases, cervico-shoulder flap in 2 cases, trapizius myocutaneous flap in 3 cases, and radial artery retro-island flap in 2 cases. The flap sizes ranged from 5 cm ×4 cm to 18 cm ×12 cm. Results Of 70 cases, 67 skin flaps survived and incision healed by first intention; 2 flaps necrosed at distal part（〈 1 cm） and healed by second intention after dressing change; 1 flap infected and was treated with symptomatic medication. All the donor sites healed by first intention. Fifty-five patients were followed up for 1 to 5 years and 5 cases had tumor recurrence. In patients receiving skin transplantation, 1 case of squamous carcinoma and 1 case of fibrous sarcoma relapsed after 1 year and 2.5 years respectively and were given radical resection and skin flap grafting; in patients receiving skin flap grafting, 1 case of vasculosarcoma and 1 case of squamous carcinoma relapsed after 6 months and 3 months respectively, and gave up treatment; 1 case of fibrous sarcoma relapsed after 2 years and was given radical resection and skin flap grafting. The other cases survived and had no tumor recurrence. Conclusion Scalp malignant tumors should be diagnosised and treated as early as possible. Clearing up completely by surgery is an effective method.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第1期59-62,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
头皮恶性肿瘤
皮瓣
植皮
修复
Scalp malignant tumor Skin flap Skin transplantation Repair
