儿童头皮和颅骨皮样囊肿的临床特点和手术疗效

Clinical characteristics and surgical outcomes of dermoid cyst of scalp and skull in children

目的探讨儿童头皮和颅骨皮样囊肿的临床特点和手术疗效。方法回顾性纳入2017年7月至2018年7月南京医科大学附属儿童医院神经外科采用手术治疗,且术后经病理学证实为皮样囊肿的患儿121例,占同期手术治疗的头皮及颅骨肿物患者的50. 4%(121/240),≤3岁者占72.7%(88/121)。其中病灶位于头皮者45例(头皮组),侵犯颅骨者(颅骨组)76例(颅骨浅层受压者16例,颅骨部分受压者37例,颅骨全层受压者23例)。分析两组患儿的临床特点和手术疗效。结果头皮组与颅骨组患儿比较,性别、年龄分布差异均无统计学意义(均P>0.05)o 45例头皮组患儿中,42例(93.3%)病灶位于颅骨骨板,3例(6. 7%)位于骨缝;76例颅骨组患儿中,51例(67.1%)病灶位于颅骨骨板,25例(32.9%)位于骨缝,差异有统计学意义(P<0.01)。76例颅骨组患儿中,53例部分侵犯颅骨,23例穿透颅骨。部分侵犯颅骨者中,46例(86.8%)病灶位于颅骨骨板,7例(13.2%)位于骨缝;穿透颅骨者中,5例(21.7%)病灶位于颅骨骨板,18例(78.3%)位于骨缝,差异有统计学意义(P<0.01)o 121例患儿共完整切除病灶121处,无手术相关并发症。术后随访3?15个月,均未见肿物复发<结论皮样囊肿是儿童头皮及颅骨常见肿物,低龄儿童发生率高。病灶可以局限于头皮,或穿透颅骨不同层次。位于骨缝处的病灶更易侵犯颅骨及穿透颅骨。早期手术治疗可以获得良好的疗效。

Objective To investigate the clinical characteristics and surgical outcomes of dermoid cysts of scalp and skull in children. Methods From July 2017 to July 2018, 121 children with dermoid cysts were admitted to Department of Neurosurgery, Children zs Hospital Affiliated to Nanjing Medical University. The pathological findings showed that they accounted for 50.4%( 121 /240) of the patients with scalp and skull tumors treated during the same period. Among them, 72. 7%( 88/121 ) were less than 3 years old. Among them, 45 cases were located on the scalp and 76 cases liad invasion on the skull (superficially compression in 16 cases, partially compression in 37 and full-thickness compression in 23 ). Results There was no significant difference in sex and age distribution between scalp group and skull group (both P >0. 05). Among 45 cases of scalp group, 42 (93. 3%) cases were located in the skull plate, 3 (6. 7%) in the suture, while in 76 cases of skull group, 51 (67. 1%) were located in the skull plate and 25 (32. 9%) in the suture. The difference was significant (P <0. 01). Among 76 cases of skull group, 53 cases had partial invasion on the skull and 23 had penetration of the skull. In 46 ( 86. 8%) cases with partial skull invasion, the lesion was located in the skull plate in 7 (13. 2%) cases, 5 (21.7%) cases had the lesion in the skull plate and 18 (78. 3%) had the lesion in the skull suture ( P <0. 01). A total of 121 lesions were completely removed in 121 children. No operative complications occurred. Follow-up for 3 to 15 months showed no recurrence. Conclusions Dermoid cyst is a common mass of scalp and skull in children. The incidence of dermoid cyst in young children seems high. The lesions may be confined to the scalp or penetrate various levels of the skull. The lesions located at the suture are more likely to invade and penetrate the skull. Early surgical treatment could achieve good results.