黑素细胞来源纵行黑甲的临床特点及手术治疗的初步研究

Clinical Character and Surgery Treatment of Longitudinal Melanonychia from Melanocyte: A Preliminary Study

目的:分析良性纵行黑甲的临床特点,并初步探讨如何合理选择外科术式治疗纵行黑甲。方法:回顾分析四川大学华西医院皮肤科2016年2月-2017年12月手术治疗的155例纵行黑甲患者的临床资料,然后根据其甲黑线的部位、宽度及深度采取不同的手术方式切除皮损,包括:(1)甲床及甲母质直接切除缝合法;(2)甲床及甲母质切除后皮瓣缝合法;(3)甲母质及甲床薄层切削法;(4)侧甲皱襞及其甲母质切除法,术后跟踪随访并判断临床疗效。结果:155例患者的手术中,直接切缝法手术时间最短、拆线快复发率低,仅适用于病灶宽度小于3mm者;甲床及甲母质切除后皮瓣缝合、手术时间长,术后易造成指(趾)甲畸形;薄层切削手术时间较快,但复发率较高;侧甲皱襞及其甲母质切除法炎症轻、不易产生甲畸形,仅适用于靠近侧面甲皱的病变。结论:黑甲可能是良性也可能是恶性,临床需特别注意,根据患者纵行黑甲的不同部位、宽度、深度选择个体化手术方式临床非常必要。

Objective Discuss the clinical feature of benign longitudinal melanonychia(LM)and several techniques to remove the lesion.Methods Retrospective analysis the 155 cases of LM from February 2016 to December 2017 of West China Hospital dermatologic department.Use elliptical excision,flap of matrix,angential excision and lateral longitudinal excision to remove the lesion.Results In surgery treatment of 155 patients,elliptical excision have character of spending less time,the inflammation and oozing is few,fast suture removing and lower recurrence rate and this method only can used in cases lesion is narrower than 3mm.Flap of matrix spend more time than other tree methods and trend to create malformation in nail.Tangential excision can performed very fast,but recurrence rate is high.Lateral longitudinal excision create little inflammation and less malformation of nail,but only can use in cases lesion near the lateral nail fold.Conclusion LM could have different diagnosis,location,width and depth,choice suitable technique according these condition are necessary.