儿童先天性巨痣的病理特征及手术疗效探讨

The discussion over pathological features and the effect of surgical treatment of children with giant pigmented nevus

目的探讨儿童先天性巨痣的治疗方法、手术时机及其与病理之间的关系。方法回顾性分析近年来本院收治的28例先天性巨痣患儿临床资料,其中男18例,女10例;头面部13例,肢体及躯干部15例,术后标本进行HE染色。1例头部发际线以内巨痣采用埋置扩张器,二期手术切除;23例采用一次性全部切除植皮;1例采用分次切除病变组织,植皮覆盖创面的方法;其余3例因痣体大,患儿年龄大肢体长,供皮不够,且位于跨关节处,采取部分切除植皮。结果所切除的巨痣血液供应均较正常皮肤丰富,累及浅筋膜者皮下脂肪均较稀少。HE染色病理检查2例为黑色素细胞交界痣(7%),26例为复合痣(93%),均未发生恶变。28例术后伤口均Ⅰ期愈合,愈合均满意。结论先天性巨痣具有良性肿瘤的细胞生物学特性,尽早进行整形外科手术可减轻手术瘢痕,较好恢复患儿外形及功能,去除面积及所需去除组织少,且病理上可减少恶变几率,较大程度上减轻患者的心理伤害。

Objective To explore the association among surgical techniques,surgical timing and pathological features of children Giant Pigmented Nevus. Methods 28 cases with Giant Pigmented Nevus on children who were treated in our deparment from June 2009 to December 2014,were retrospectively analyzed. These cases include 18 males and 10 females,in which 13 cases on the head and face region and 15 cases on the body and limb region. The samples are stained by using HE staining. One case of infants with giant pigmented nevi inside the hairline was cured by two-stage operation with the skin expander; 23 patients received full-thickness skin graft to fix the defect after excision of giant nevus; one case undertook resection surgery in different stages,with graft covering the wound; Three cases of older children undertook partial resection due to the large area of nevi,which was crossing the joints and lacking of enough skin for grafting. Results Resected giant nevus had better blood supply than the normal skin. Subcutaneous lipid was rare due to the association with the superficial fascia. HE staining pathological examination showed that 2 cases were melanocytes borderline nevus( 7%),26 cases were compound nevus( 93%),and no malignant change was occurred. In 28 cases,all the wounds were healed in I stage,and the healing was satisfactory. Conclusion Congenital giant nevus has the cellular biological characteristics of benign tumors,and early plastic surgery can effectively reduce the surgical scar. Surgery can better restore the shape and function of children,remove the area and need less tissue,and reduce the risk of malignant transformation in pathology,to a large extent,reduce the psychological harm of patients.