获得性甲周纤维角化瘤临床病理特征分析及外科治疗方法探讨

Clinical pathological analysis and surgical treatment of acquired periungual fibrokeratoma

目的 探讨获得性甲周纤维角化瘤（APF）临床病理特征及外科治疗方法.方法 选取2009年9月至2015年3月首都医科大学附属北京安贞医院皮肤性病科收治的7例APF患者,对其临床表现、组织病理学特征、外科治疗结果进行分析.结果 7例患者中男2例,女5例,以指（趾）部指状新生物为主诉就诊;病程6个月至3年.6例APF发生在甲板与甲小皮之间,1例AFP发生于甲板上,肿物长轴与侧甲沟走行一致,顶部角化,质硬,损害下甲板形成纵行凹陷.组织病理学检查均示表皮角化过度,棘层肥厚,真皮可见大量增生的胶原纤维及成纤维细胞,增生胶原排列与损害长轴一致.6例患者行外科手术切除治疗,1例APF患者激光治疗后复发,改用外科手术切除.术中切开甲廓,暴露、分离并切除肿物,保留甲母质,术后指（趾）甲恢复良好,未见复发.结论 APF根据特征性临床表现及组织病理易被诊断,治疗以保留甲母质的外科手术切除为佳.

Objective To investigate the clinical pathological characteristics and surgical treatment of acquired periungual fibrokeratoma（APF）.Methods Data of 7 cases of APF,including clinical features,pathological characteristics and surgical treatment outcome,was retrospectively analyzed.Results There were 2 males and 5 females;symptoms included a digital neoplasm on the finger or toe for 0.5 to 3 years.The lesion was located beneath the eponychium in 6 cases and it was on nail plate in 1 case.The lesions paralleled to the lateral nail groove and was firm with keratinization,which induced a shallow concave of the nail plate under the lesion.The pathological findings included hyperkeratosis,epidermis acanthosis,proliferation offibroblast cells,closely packed collagen bundles.which mostly oriented in the longitudinal axis of the lesion.Six cases of APF were treated with surgical excision;1 case of APF relapsed after laser treatment and the patient receivedsurgical excision.After incisions of the paronychium,the tumor was exposed,dissected and excised with preserving nail matrix.APF showed no recurrence with normal nail appearance after surgical excision.Conclusions APF is easy to be diagnosed with typical clinical and pathological characteristics.Surgical excision with preserving nail matrix is effective.