遵循"AISS"策略精准治疗躯干部巨大神经纤维瘤

The"AISS"strategy for giant neurofibroma in the trunk

目的:以体表肿瘤精准治疗为目标,探讨躯干部位巨大神经纤维瘤的外科治疗策略。方法:回顾性分析2021年1月至2023年3月陆军军医大学第一附属医院整形外科收治的躯干部巨大神经纤维瘤患者资料,均遵循"AISS"策略进行精准治疗,即:(1)术前储存自体成分血(autologous blood storage);(2)术前介入栓塞瘤体关键供血动脉(interventional embolization);(3)术中精准切除瘤体(surgical resection);(4)反取瘤体断层皮片回植修复继发巨大创面(skin graft)。记录患者术前基线资料、自体成分血存储量、介入栓塞具体血管及方法、术中出血量、术中输血量、围术期并发症等指标,并随访肿瘤复发情况。结果:共纳入5例患者,男4例,女1例,年龄22~32岁。5例患者瘤体主要位于躯干部(颈、胸、腰、骶尾部),大小为21 cm×20 cm~76 cm×66 cm。术前完成自体成分血储存800~1 600 ml,术前介入栓塞主要瘤体供血血管包括:胸廓内动脉、肋间动脉、胸廓外动脉、腰动脉、腹壁下动脉、髂腰动脉及髂内动脉。术中出血量150~3 000 ml,输注自体存储血完成手术。所有患者未发生大出血、发热、感染等并发症,1例患者移植瘤体断层皮片小范围成活欠佳,位于双侧髂窝部位,后续通过换药与刃厚皮片移植治愈。术后随访6~24个月,未见瘤体复发。结论:"AISS"策略不仅能安全、精准地治疗躯干部巨大神经纤维瘤,而且能有效减少术中出血量及并发症,一期修复巨大创面,防止肿瘤复发,提高患者满意度。

Objective To investigate the surgical strategy for giant neurofibromas in the trunk with the goal of precise treatment of superficial tumors.Methods We retrospectively analyzed the patients with giant neurofibroma of the trunk who admitted to the Department of Plastic Surgery,Southwest Hospital of Army Medical University from January 2021 to March 2023.All patients were treated with"AISS"strategy:(1)autologous blood storage;(2)interventional embolization of the key blood supply artery of the tumor;(3)surgical resection of the tumor;(4)skin graft was harvested from the tumor to repair the secondary defect.Patient demographics,autologous blood storage volume,specific blood vessels and methods of interventional embolization,intraoperative blood loss,intraoperative blood transfusion,complications,and tumor recurrence at follow-ups were documented.Results A total of 5 patients were enrolled,including 4 males and 1 female,aged 22-32 years.The tumors size ranged from 21 cm×20 cm to 76 cm×66 cm,which were located in the trunk(neck,chest,waist,sacrococcygeal region).The volume of autologous blood storage ranged from 800 to 1600 ml before the operation.The main blood supply vessels of the tumor were embolized before the operation,including:internal thoracic artery,intercostal artery,external thoracic artery,lumbar artery,inferior epigastric artery,iliolumbar artery and internal iliac artery.All patients underwent radical resection.The intraoperative blood loss was 150-3000 ml.Patients were transfused with their autologous blood during the operation.There were no severe intraoperative hemorrhage,adverse effects of blood transfusion or infection were not noted.A small skin graft necrosis was noticed in the bilateral iliac fossa in one patient,which was subsequently resolved through dressing change and blade-thickness skin graft transplantation.No tumor recurrence was found during the follow-up period(6-24 months).Conclusion "AISS"strategy not only safely and accurately treat giant neurofibroma of trunk,but also effectively reduce the intraoperative blood loss and complications,repair of huge wounds in one stage,preventing the recurrence rate of tumors and improving patient satisfaction.