伴严重肝功能不全的眼睑巨大结节性黄色瘤整形外科治疗体会

Orthopedic treatment observation of huge eyelids nodular xanthoma patient with severe liver dysfunction

目的:探讨运用整形外科手段对伴有严重肝功能不全的双侧眼睑巨大结节性黄色瘤进行治疗的策略及意义。方法:对1例伴有严重肝功能损害的双侧上下眼睑巨大结节性黄色瘤患者首先采取营养支持治疗,当条件许可时积极手术,先切除较大侧结节,创面移植全厚皮片,待完全愈合后,择期手术切除另一侧病灶。结果:左侧上下眼睑瘤体完全切除,创面植皮存活,眼睑运动功能良好,视物无遮挡,术后无倒睫、睑外翻等并发症,随访1年无复发,生活质量改善,另一侧等待手术。结论:对于伴有严重肝功能不全的眼睑巨大结节性黄色瘤患者,为改善其生活质量,降低生活与工作中对他人的依赖程度,可进行积极术前准备,在手术条件允许下可以通过整形外科技术治疗获得满意的效果。

Objective To discuss the strategies and significance of using plastic surgery techniques to treat a patient who suffered from huge nodular xanthoma on bilateral upper and lower eyelid and from the serious liver dysfunction meanwhile.Methods Firstly the nutrition support therapy was done to improve the basal condition of the patient,and then the positive surgery treatment should be performed as long as the conditions permitted（such as the albumin≥30g/dl and hemoglobin≥7g/dl）.Two larger nodule xanthomes grown on the left upper and lower eyelid were moved first,and the wounds following the resection of nodule xanthomes were repaired by full-thick skin graft technique.After being completely healed,the operation on the other side would be performed.Results The two larger nodules grown on left upper and lower eyelid were completely removed,and skin graft survival well.After operation,the movement functions of eyelid was remaind well,and the obstructing the view that caused by the nodule was eliminated completly.There were no postoperative complications such as trichiasis and ectropion.This patient was followed up at 1-year of postoperation,any recurrence of nodule could not be found,and the quality of life of patient was improved greatly,surgery treatment enabled this patient do many things without helps from other people.The patient was very satisfactory and waiting for the next surgery treatment.Conclusions Even if this patient have suffered from serious liver dysfunction,it is necessary to remove the huge nodular xanthoma grown on the eyelids that can make things unconvenient for patient.Excision of huge nodular xanthoma grown on the eyelids can improve quality of life and can reduce the dependence on others in the life and work.So long as there are adequate and detailed preoperative preparations,the operation is safe.