特殊类型巨型先天性黑色素细胞痣个性化手术治疗

Personalized surgical treatment of peculiar giant congenital melanocytic nevus

目的探讨特殊类型巨型先天性黑色素细胞痣(巨痣)的手术方法及效果。方法特殊类型巨痣患儿15例,病变位于头面部5例、躯干3例、上肢3例、下肢4例,病变面积10cm×12cm^16cm×24cm;于一次全部切除或分期切除病变后,个性化选择植皮或扩张皮瓣转移修复创面。结果一次性全部切除病变者植皮修复创面2例、扩张皮瓣修复创面3例,分期切除病变者植皮修复创面5例、扩张皮瓣修复创面3例、植皮+扩张皮瓣修复创面2例;手术过程均顺利,术后植皮或扩张皮瓣均成活;随访3~8个月,病变无复发,功能良好,外观满意。结论手术治疗特殊类型巨痣应兼顾术后功能和美观,病变一次或分次切除+植皮或扩张皮瓣转移修复创面疗效满意。

Objective To investigate the personalized surgical method and its effect on peculiar giant congenital melanocytic nevus.Methods In 15 cases of peculiar giant congenital melanocytic nevus,the lesion was located on the head and face in 5 cases,torso in 3 cases,upper limbs in 3 cases,and lower limbs in 4 cases,ranging from 10cm×12cm to 16cm×24cm.After excision of lesions in one stage or more,personalized treatment methods of skin graft or expanded flaps transplant were selected to repair the wounds.Results In the patients receiving one-stage excision of lesion,2 patients underwent skin graft repair,and 3 patients underwent expanded flaps repair.In the patients receiving excision of lesion in more stages,5 underwent skin graft repair,3 underwent expanded flaps repair,and 2 underwent skin graft plus expanded flaps repair.All the surgical procedures were completed smoothly.The grafted skin and expanded flaps survived well.The 3-to 8-month follow-up showed no recurrence,with good function and appearance recovery.Conclusion The function and appearance should be considered in surgical treatment of peculiar giant nevus.Excision of lesion in one stage or more plus skin graft or expanded flap transplanting repair will achieve a satisfactory therapeutic effect.