体表恶性肿瘤切除术中异种猪皮暂时覆盖增加手术精确性应用探析.docVIP

体表恶性肿瘤切除术中异种猪皮暂时覆盖增加手术精确性应用探析[摘要]目的:总结特殊情况体表恶性肿瘤切除术中异种猪皮暂时覆盖提高手术精确性的临床经验。方法:Ⅰ期扩大切除肿瘤后,处理过的猪皮覆盖创面,等待病理检查结果。证实肿瘤切除干净,则第二次植皮或皮瓣修复创面,若某个切缘仍有瘤体残留,则据情况决定再扩大切除未净区域后植皮或皮瓣修复创面。结果:第二次需要再次扩大切除的5例,总发生率为15%,另外27例避免了在术中快速冰冻切片病理检查结果有疑虑时盲目再扩大切除。结论:采用这一方法提高了治疗上的精确性。 [关键词]体表肿瘤;切除;猪皮;病理 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)05-0659-02 Temprorarily covered by heterogeneous skin can increase the surgical accuracy in Superficial m alignant tumor resection during Special circumstances ZHENG Dong-feng, TAN Qian,WU Jie,ZHOU Hong-reng,CHEN Xi,XU Peng,WANG Shu-qin (Department of Plastic Surgery,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China) Abstract:ObjectiveTo summarize the experience of heterogeneous skin to increase the surgical accuracy in Superficial m alignant tumor resection during Special circumstances.MethodsWounds are covered by the heterogeneous skin after tumor extended resection,waiting for the results of pathological examination. If it is confirmed tumor excision,the wounds are repaired by skin graft or flap, if there is still residual tumor,extended resection is needed ,following by skin graft or flap to repair.Results5 cases still need extended resection, accounted for 15% of the total number of cases. Moreover, blind extended resection is avoided in other 27 cases while the results of pathological examination is doubted.ConclusionThis method can improve the accuracy of the treatment Key words: surface tumor; removal; heterogeneous skin; pathology 我科2004年1月至2009年10月间共进行近200例多种类型体表恶性肿瘤扩大切除整复手术,术中均采用快速冰冻病理切片检查以明确肿瘤性质及肿瘤边缘基底切除干净情况。但有32例特殊情况的体表恶性肿瘤,对肿瘤性质或肿瘤基底及切缘是否干净的情况,术中病理报告存在疑虑,无法准确报告。笔者为提高手术的精确性,避免治疗上的盲目性,随意性,采用术中异种猪皮暂时覆盖,根据常规病理检查的结果(必要时辅助免疫组化检查),决定Ⅱ期是否再扩大切除或直接修复创面,效果满意,总结报道如下。 1资料和方法 1.1 一般资料:本组32例,其中男15例、女17例,年龄22～86岁。其中鳞形细胞癌4例,基底细胞癌3例,皮肤隆突性纤维肉瘤4例,乳外Paget’s病4例,侵袭性纤维瘤病4例,meckel细胞癌2例,透明细胞肉瘤2例,纤维组织细胞瘤2例,粘液性纤维肉瘤2例,角化棘皮瘤2例,日光性角化病3例。位于颜面,五官附近的20例,会阴部2例,颅顶部3例,锁骨上窝2例,乳房周围2例,腰骶部1例,脐周1例,腋顶部1例。 1.2治疗方法