神经纤维瘤的综合性外科治疗

The integrated surgical treatment of neurofibroma

目的:根据神经纤维瘤NF的具体情况,采用各种方法进行综合性外科治疗。方法:回顾性分析南京军区南京总医院在1978年12月至2007年5月期间手术切除的30例NF患者资料。结果:30例患者NF分布于全身各处,大小不一,最大瘤体的面积达到60 cm×120 cm。瘤体基本切除,直接缝合13例;瘤体基本切除,植皮修复6例;瘤体大部分切除,设计皮瓣修复10例;埋置扩张器,二期手术切除瘤体并行扩张皮瓣转移修复1例。其中1例右侧臀部大腿巨大NF患者,采用血管造影栓塞营养动脉、瘤体高位悬吊、瘤体边缘缝扎、术中控制性低血压及自体血回输等方法,切除瘤体的重量达11 kg。所有患者均无并发症发生。部分患者随访至今,其中5例肿瘤复发,再次手术切除。结论:应用整形外科技术,并联合麻醉科、影像科等其他学科的多种方法,综合治疗NF,安全性高,效果较满意。

Objective ： To investigate the integrated surgical treatment of neurofibroma. Methods ： Retrospective analysis of clinical data about the operation of neurofibroma from December, 1978 to May, 2007 was carried out in our hospital. Results：Thirty cases with complete document were analyzed. The neurofibromas with various volume scattered throughout the body. The largest one was 60 cm x 120 cm. Thirteen cases were excised basically with primary wound closure. Six cases were excised basically and the wounds were repaired by skin grafts. Ten cases were excised subtotally and the wound were repaired by skin flaps. One case accepted skin expansion and the tumor was excised and the wound was repaired subsequently by expanded skin flap. One of these cases was a huge neurofibroma on the haunch and thigh. We embolized the nutritional arteries by DSA preoperatively, suspended the tumor, made hemming-stitch around the tumor, lowered the blood pressure and transfused the effluent blood during operation. With these methods, we excised the 11 kg tumor safely. No complications occurred in any of these cases. In long-termed follow-up, 5 cases recurred and accepted repeat operations. Conclusion：The multi-disciplinary surgical treatment, including plastic surgery, anesthesiology, radiology and others,could achieve good results in the treatment of neurofibroma.