Mohs外科技术联合皮瓣修复技术治疗头颈颌面部皮肤恶性肿瘤的近期疗效观察

Observation of short-term efficacy on Mohs surgical technique combined with flap repair technique in treatment of head,neck and maxillofacial skin cancer

目的:分析Mohs外科技术与皮瓣修复技术联合用于头颈颌面部皮肤恶性肿瘤治疗的价值。方法:选择2014年7月至2018年7月收治的头颈颌面部皮肤恶性肿瘤200例患者作为研究对象,随机将其分为对照组、研究组,各100例。全部患者修复方式均采用皮瓣修复技术,对照组外科切除采用传统切除方式,研究组患者则采用Mohs外科技术,手术结束后随访时间为1年。比较两组患者手术切除情况,包括病理复检切缘残留肿瘤率、随访结束时复发率;记录并比较两组患者创面最长径、创面愈合时间;记录并比较两组术后短期切口裂开、继发畸形、皮瓣坏死等并发症发生情况;设计外观满意度调查问卷,调查并比较两组患者对术后颌面部外观满意度。结果:研究组患者病理检查切缘残留肿瘤率、随访结束时复发率均低于对照组,差异有统计学意义(P<0.05);研究组创面最长径小于对照组(P<0.05),创面愈合时间与对照组比较差异无统计学意义(P>0.05);研究组术后切口裂开与对照组比较无统计学差异(P>0.05),继发畸形发生率比对照组低,差异有统计学意义(P<0.05);组间皮瓣坏死发生率比较差异无统计学意义(P>0.05);研究组患者术后外观满意率(82.00%)高于对照组(60.00%),差异有统计学意义(P<0.05)。结论:Mohs外科技术与皮瓣修复术联合治疗头颈颌面部皮肤恶性肿瘤,较传统切除术患者术后创面小、切缘残留肿瘤情况少,复发率大大降低,继发畸形少,患者对外观满意度高,治疗效果及安全性均理想,值得推广应用。

Objective:To analyze the value of Mohs surgical technique combined with flap repair technique in treatment of head,neck and maxillofacial skin cancer.Methods:200 patients with head,neck and maxillofacial skin cancer who were admitted in the hospital from July 2014 to July 2018 were selected as the subjects.All selected patients were randomly divided into control group and research group,with 100 cases in each group.All the patients were given flap repair technique.Control group underwent conventional surgical excision,and research group was given Mohs surgical technique.They were given 1 year of follow-up after surgery.The surgical resection was compared between the two groups,including the residual tumor rate of the pathological resection margin and the recurrence rate at the end of follow-up.The maximum diameter of wound and wound healing time in the two groups were recorded and compared.The incidence of complications such as postoperative short-term incision rupture,secondary malformation and skin flap necrosis were recorded and compared between the two groups.The appearance satisfaction questionnaire was designed to investigate and compare the satisfaction with postoperative maxillofacial appearance between the two groups.Results:The residual tumor rate of the pathological resection margin and the recurrence rate at the end of follow-up in research group were lower than those in control group(P<0.05).The maximum diameter of wound in research group was smaller than that in control group(P<0.05),and there was no statistically significant difference between the two groups in the wound healing time(P>0.05).There was no statistically significant difference between research group and control group in the postoperative incision rupture(P>0.05).The incidence of secondary malformation in research group was lower than that in control group(P<0.05).There was no statistically significant difference between the two groups in the incidence of skin flap necrosis(P>0.05).The postoperative appearance satisfaction in research group(82.00%)was higher than that in control group(60.00%)(P<0.05).Conclusion:Compared with conventional resection,Mohs surgical technique combined with flap repair in treatment of head,neck and maxillofacial skin cancer has small postoperative wound and less residual tumor of the pathological resection margin.It can decrease the recurrence rate,have less secondary malformation,achieve high appearance satisfaction,and have ideal curative effects and safety,which is worthy of promotion and application.