儿童面部黑色素痣诊治379例

Diagnosis and treatment of facial nevi in children

目的回顾性分析2010年1月至2014年12月在本院经手术治疗的379例面部黑色素痣患儿临床资料,总结儿童面部黑色素痣的手术治疗经验。方法379例中,男175例,女204例;年龄44 d至16岁。采用3种术式:单次(235例)或分次(71例)切除缝合,切除加全厚植皮(38例),切除加皮瓣修复,邻近皮瓣转移(34例),1例左面部巨痣行痣大部分切除加股前外游离皮瓣转移修复。采用皮肤科医师和患儿家属双盲主观评价疗效,评价内容为切口瘢痕、面部畸形、色差。结果除1例股前外游离皮瓣转移患儿游离皮瓣吻合口栓塞改为全厚植皮外,所有患儿均完整切除面部黑色素痣,切口Ⅰ级愈合。所有单次或分次切除缝合、临近皮瓣转移者未出现明显瘢痕增生或挛缩,皮肤色泽和弹性与正常皮肤接近,除部分邻近皮瓣转移患儿家长对附加切口不满意外,均获得满意评价。全厚植皮术者植皮区创缘发生轻度瘢痕增生,植皮区色素沉着。所有患儿未继发面部畸形。结论儿童面部黑色素痣的手术设计需兼顾其所处面部美容单位、面积大小,遵循面部美容单位自然的分界线及面部皱纹线走向,选择适宜的切除缝合、皮瓣转移、全厚植皮等术式进行修复,术后可获得较好的美容效果。

Objetive To retrospectively analyze the clinical data of 379 cases of facial nevi in children treated in our department, from Jan. 2010 to Dec. 2014. Methods The 379 cases included 175 male and 204 female ,with their age ranging from 44 days to 16 years old. Three techniques were used： single （235 eases） or fractional （71 cases） resection and suture, resection and full thickness skin graft （38 cases）, resection and skin flap to repair, adjacent skin flap transfer （34 cases）, left facial giant nevus, nevus subtotal resection plus free flap transfer to repair（ 1 case）. The effect were double blind subjective evaluated by the families and dermatologists, evaluation of the scar, facial deformity, color. Results Except for 1 case of femoral anterolateral free flap transfer with free flap anastomotie thrombosis was changed for full thickness skin graft, all children were completely excised facial nevi, incision grade I healing. All single or fractional excision and suture, adja- cent skin flap transfer were not complicated with obvious scar hyperplasia or contraeture, skin color and elasticity were close to normal skin. Wound mild hyperplasia was found in the ease of full thickness skin graft. All children had no facial deformity. Conclusions The operation design of facial nevi of children need to be taken into account in the facial beauty unit and the nevi size, followed by the natural dividing line of facial beauty unit and facial wrinkles lines to select the appropriate resection and suture, skip flap transfer and full - thickness skin grafting, better cosmetic effect can be obtained.