甲外血管球瘤诊断与治疗的相关因素分析

The related factors of the diagnosis and treatment of extraungual glomus tmnor

目的分析甲外血管球瘤诊断与治疗的相关因素。方法对2005年1月至2009年12月手术治疗的22例甲外血管球瘤进行回顾性分析。22例中，男女比例为1：1．75（8：14），年龄为24—63岁（平均39．4岁），发病至手术时间为3个月至28年（平均84．8个月）。血管球瘤位于指腹17例（占77．3％，17／22），指近节掌侧2例（占9．1％，2／22），手掌2例（占9．1％，2／22），内踝1例（占4．5％，1／22）。其中多发瘤2例（占9．1％，2／22），外伤史2例（占9．1％，2／22），可及肿物9例（占加．9％，9／22），Love试验阳性22例（占100％，22／22），冷敏感试验阳性7例（占31．8％，7／22）。临床误诊12例（占54．5％，12／22），B超发现率22例（占100％，22／22）。血管球瘤平均直径为4．1mm（2．0—7．0mm）。结果22例术后随访时间为4。144个月，其中19例（占87．4％，19／22）术后痊愈，白发痛及触痛消失。肿瘤复发3例（占13．6％，3／22），再次术后未见复发。结论甲外血管球瘤缺乏典型的症状体征，诊断困难，提高对血管球瘤的认识，运用Love试验及高频B超，可有效地避免误、漏诊。完整切除肿瘤可以获得明确的疗效。

Objective To analyze the related factors of the diagnosis and treatment of extraungual glomus tumors. Methods A retrospective analysis of 22 cases of extraangual glomus tumor treated from January 2005 to December 2009 were conducted. There were 8 male patients and 14 female patients with a male- to-female ratio of 1 ： 1.75. The average age was 39.4 years （range, 24 to 63 years）. The average disease course was 84.8 months （range, 3 months to 28 years）. The glomus tumors were located in the pulp in 17 cases （77.3%, 17/22）, on the palmar side of the proximal finger in 2 cases （9.1%, 2/22）, on the palm of the hand in 2 cases （9.1%, 2/22）, and at the medial malleolus in 1 case （4.5%, 1/22）. There were 2 cases （9.1%,2/22） with multiple tumors, 2 cases （9.1%,2/22） with previous injury, and 9 cases （40.9%,9/22） with palpable tumors. All （ 100%,22/22） cases had positive Love test, while cold-intolerance test was positive in 7 cases （31.8%, 7/22）. The clinical misdiagnosis rate was 54.5% （12/22）. Ultrasonographic diagnosis was correct in all 22 cases （100% ,22/22）. The average diameter of the tumor was 4.1 mm （range, 2.0 to 7.0 mm）. Results Postoperative follow-up period ranged from 4 months to 144 months. Cure was observed in 19 cases in which spontaneous pain and tenderness disappeared. Local recurrence occurred in 3 （13.6%） patients. No recurrence was observed after the second surgical excision. Conclusion Extraungual glomus tumors are difficult to diagnose due to the lack of specific symptoms and physical signs. A better understanding of the tumor, Love test and ultrasound examination are effective methods for reducing the rate of misdiagnosis. Complete excision of the tumor is an effective treatment method.