眼睑分裂痣的手术方式探讨

Study of surgical techniques of divided nevus of eyelids

目的探讨不同部位和大小眼睑分裂痣的手术方式及效果。方法回顾性系列病例研究。收集本中心1997年7月至2006年11月的眼睑分裂痣病例共30例（30只眼），按不同部位，侵犯范围的大小分别采取了不同的手术方法。包括：分裂痣切除后直接缝合3例；分裂痣切除后I期行游离皮肤移植术5例；分裂痣切除后皮瓣转移术，手术分两期进行，I期行上睑或下睑手术，3个月后Ⅱ期行另一眼睑手术，共22例，其中对侵及泪小点的分裂痣将色素痣和受侵犯的泪小点一起切除后行泪小管VI再造和睑成形术8例。结果30例患者随访2～11年，平均随访时间60个月。有1例术后2年复发，随诊5年再次手术，术后病理发现有恶变，经再次行Mohs眼睑恶性肿瘤组织学控制性切除术，术后未见复发。其余病例未见复发和恶变。结论眼睑分裂痣切除术采用分期手术转移皮瓣法修复眼睑比游离植皮法疗效更满意。对分裂痣切除术后的病例需密切观察，以便早期发现恶变。

Objective To investigate the surgical techniques of divided nevus of the eyelids with different locations and sizes. Methods Retrospective observational case series. Thirty cases （30 eyes） of divided nevus of the eyelids in Zhongshan Ophthalmic Center from July 1997 to November 2006 were retrospectively reviewed. There were three different surgical methods. Excision of the nevus and direct suture after excision in 3 cases. Excision of the nevus and free skin graft transplantation in 5 cases. Excision of the nevus and transfer of skin flap, which included a two stages reconstruction, was performed in 22 cases. The upper or lower eyelid was treated first and another eyelid was treated after three months. Lacrimal punctum and lacrimal canaliculus were excised if they were involved in 8 cases among 22 cases. Results The mean follow-up time was 60 months （ranging from 2 years to 11 years ）. Only one case recurred after two years during follow-up and was excised after five years. Pathologic examination indicated malignant transformation. Excision with histopathological control was performed and the nevus did not recur during follow-up time. Recurrence or malignant transformation did not occur in other cases. Aesthetical results of skin flap transplantation were better than skin graft transplantation. Conclusions The results of two stages reconstruction and transfer of skin flap after excision of the divided nevus are better than free skin graft transplantation. Close observation is required after excision of the divided nevus for early detection of malignant transformation.