前臂及手掌部丛状神经纤维瘤的显微外科治疗

Microsurgical treatment of the plexiform neurofibroma in the forearm and palm

目的探讨应用显微外科技术治疗前臂及手掌部丛状神经纤维瘤(PN)的临床效果。方法2014年1月至2017年6月,应用神经血管移植、显微镜下分离及缝接等显微外科技术治疗前臂及手掌部PN 6例,其中男4例,女2例;年龄2~18岁,平均9.2岁。右前臂尺神经、正中神经及其手掌部分支1例,右前臂正中神经及其手掌部分支2例,左前臂正中神经及其手掌部分支2例,左前臂尺神经及其手掌部分支1例。患者术后功能、感觉等均采用门诊随访的方法进行评定。结果6例病理结果均显示为PN,切口均一期缝合。随访6~36个月,平均18个月,所有切口未见明显瘢痕组织形成,其中年龄最小的患者手掌部PN术后复发,经二期手术再次切除,其余5例患者在随访时间内未见复发。正中神经、尺神经PN患者患肢各指指端两点辨别觉为2~5 mm,平均3.30 mm;正中神经PN患者患肢拇、示、中、环指指端两点辨别觉为2~5 mm,平均2.95 mm;尺神经PN患者患肢环、小指指端两点辨别觉为3~4 mm,平均3.50 mm。前臂及手部功能按照中华医学会手外科学分会上肢部分功能评定试用标准评定:优5例,良1例。结论应用显微外科技术治疗前臂及手掌部PN,不仅术中可有效的分离肿瘤和神经纤维、有效的保护正中神经和尺神经分支及其血运,而且术后复发率低,神经功能损伤较小。

Objective To explore the clinical effect of microsurgery in the treatment of the tumor which was diagnosed with the plexiform neurofibroma(PN)of the forearm and palm.Methods From January,2014 to June,2017,6 cases of the PN in the forearm and palm were removed by microsurgery such as neurovascular transplantation,separation and anastomosis under microscope,etc.There were 4 males and 2 females,with an average age of 9.2(range,2-18)years.There was 1 case with PN of the median nerve,ulnar nerve and their branches in the right forearm and palm,2 cases with PN of the median nerve and its branches in the right forearm and palm,2 cases with PN of the median nerve and its branches in the left forearm and palm,and 1 case with PN of the ulnar nerve and its branches in the left forearm and palm.The postoperative function and feeling of the patients were evaluated by outpatient followed-up.Results The pathological results of 6 patients all showed PN,and their incisions healed primarily.The patients were followed-up for 6 to 36 months,with an average of 18 months.No obvious scar formation was observed in all incisions.Among them,PN of the palmar of the youngest patient recurred after the operation,and it was resected in a second operation.The remaining 5 patients had no recurrence during follow-up.The 2 point resolution of each fingertip of the affected limb of the patients who had median and ulnar PN was 2-5 mm,with an average of 3.30 mm;the 2 point resolution of the thumb,indicator,middle and ring fingers of the affected limbs of the patients who had median PN was 2-5 mm,with an average of 2.95 mm;the 2 point resolution of the ring and little fingers of the affected limbs of the patients who had ulnar PN was 3-4 mm,with an average of 3.50 mm.According to the related evaluation criteria made by the American Orthopedic Foot and Ankle Surgery Society(AOFAS),the results of the forearm and hand functions were excellent in 5 cases,good in 1 case.Conclusion The application of microsurgical techniques in the treatment of PN in the forearm and palm can be effective separation of tumor and nerve fibers,effectively protect the branches of the median nerve and ulnar nerve and their blood circulation,prevent recurrence and reduce nerve damage after operation.