面部神经纤维瘤的整形和显微外科治疗

Reconstructive and microsurgical treatment of facial neurofibroma

目的 研究面部神经纤维瘤及面部巨大神经纤维瘤的整形和显微外科治疗。方法 回顾性分析1993年到 1999年的 11例面部神经纤维瘤的临床诊断及治疗。结果 11例面部神经纤维瘤中 ,8例为孤立性面部神经纤维瘤 ,3例为Ⅰ型 ,其中 2例为面部巨大神经纤维瘤。对 3例巨大神经纤维瘤 ,进行肿瘤全切除 ,背阔肌肌皮瓣游离移植 ,修复皮肤缺损及面部整形。其中 1例经过手术 3次 ,第 1、2次手术失败 ,第 3次手术成功 ,将肿瘤全切除。前后共输血 2 5 0 0 0ml。 2例面部神经纤维瘤侵及眶腔内 ,手术前呈局部博动性肿块 ,分别经 3次和 4次手术完成。结论 面部巨大神经纤维瘤切除后面部缺损的修复 ,采用背阔肌肌皮瓣移植修复 ,具有塑形好 ,皮肤质地接近面部皮肤的特点。侵及眶腔内的面部神经纤维瘤 ,手术切除不易 ,手术前应有所准备。较为表浅的面部神经纤维瘤可仅给予部分切除 。

Objective To study the reconstructive and microsurgical treatment of facial neurofibroma and neurofibromatosis. Methods Retrospective analysis was carried out in 11 cases of facial neurofibroma and neurofibromatosis from 1993 to 1999. Results There were solitary neurorofibroma in eight cases and neurofibromatosis type 1 in 3 cases. Three of solitary neurofibroma was huge, after excision the facial contour reconstruction was repaired by latissimus dorsi myocutaneuos free flap in one stage. Two cases were pulsating orbital neurofibroma not only invaded the skin and subcutaneous tissue over the temple, frontal, orbital zygoma and mandible area, but also grew into orbital cavity, even the orbital apex. All of them were treated by total tumor removal and facial contour reconstruction. Conclusion Huge neurofibroma excision yields good result, the facial contour can be reconstructed by latissimus dorsi myocutaneuos free flap transfer in one stage. One must be aware of the difficulty in the excision of pulsating orbital neurofibroma preoperatively. The superficial facial neurofibroma can be removed partially or totally, and perform facial contour reconstruction one stage.(Shanghai Med J, 2000,23∶387389)