体表软组织巨大神经纤维瘤的手术治疗

Surgical Management of Giant Neurofibroma in Soft Tissue

目的探索手术治疗体表软组织巨大神经纤维瘤的方法和疗效。方法自2004年1月至2013年12月,共治疗21例体表软组织巨大神经纤维瘤患者。根据瘤体的部位、侵犯程度和局部解剖等情况,采用直接手术切除部分瘤体皮瓣修复、完整切除瘤体植皮修复、扩张器治疗逐步切除瘤体、介入栓塞主要营养动脉后切除瘤体等方法治疗。结果直接手术切除部分瘤体10例,均行皮瓣修复创面;直接手术完整切除瘤体4例,均行植皮修复;扩张器治疗切除头部瘤体1例;介入栓塞主要营养动脉后切除瘤体6例。17例手术切口一期愈合,4例患者手术切口愈合不良,经换药后愈合。所有患者术后局部外形明显改善,肢体功能得以保留并有所提高。结论手术治疗巨大神经纤维瘤能有效减轻瘤体负荷,改善外形和功能,提高患者生活质量。对于合适的患者应用扩张器治疗和术前进行营养动脉栓塞能提高手术效果,保障手术安全。

Objective To explore the effects of surgical management for the treatment of giant neurofibroma in soft tissue.Methods From January 2004 to December 2013, 21 patients with giant neurofibromas were treated surgically. According to the location and extent of the lesion, as well as the adjacent anatomy, surgical management was performed： partially or almost completely excision with surgical flap or skin graft for repairing. Expander and preoperative interventional embolization of tumor＇s nutrient arteries were used when appropriately. Results In this study, partially（n=10） or almost completely（n=4）removal of the tumor was performed. The wounds were repaired by skin flap or skin graft. One case underwent expander treatment and 6 cases underwent preoperative interventional embolization of tumor＇s nutrient arteries, which successfully reduced the bleeding in operation. Most of the skin flap and skin graft survived well（17/21）, poor wound healing was observed in 4 cases which healed by dressing. After operation, the local appearance and the function of the limbs were improved obviously. Conclusion For the giant neurofibroma, surgical treatment effectively reduces the tumor burden,rehabilitates the appearance and function, and so improves the quality of life. Skin expandor and interventional embolization of nutrient artery can be used when appropriately.