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  [摘要]目的:探讨复发性隆突性皮肤纤维肉瘤的根治性切除及创面的修复方法,以求得最佳疗效。方法:对28例复发性隆突性皮肤纤维肉瘤进行根治性切除,根据缺损创面的基底和局部情况,选择不同的材料和组织即时修复。结果:28例患者术后均一期愈合,随访2～6年无1例复发,移植组织全部成活,且原皮损处都较好地恢复了正常皮肤外观,修复效果满意。结论:应用现代整形外科技术,可有效修复局部广泛切除复发性隆突性皮肤纤维肉瘤后较大创面缺损,防止复发。

 [关键词]复发性隆突性皮肤纤维肉瘤;根治性切除;整复

 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2010)07-0960-03

 Surgical repair and treatment of recurrent dermatofibrosarcoma Protuberan

 CHEN Jian-chong,QIAN Yun-liang,ZHAN Xin-huan,HUANG Yong-xin,ZHU Jian-xian,WU Zu-huang,XIE Bao-gen

 (Department of Burn and Plastic,First Affiliated Hospital of Fuzhou General Hospital, Putian 351100,Fujian,China)

 Abstract:Objective To explore the methods of recurrent dermatofibrosarcoma protuberans of radical resection and wound repair method, in order to achieve optimal efficacy and effectiveness. Methods 28 cases of recurrent dermatofibrosarcoma protuberans to radical resection, according to the base of the wound defect and local circumstances, different materials and organization of immediate repair. Results 28 patients were healed, up from 2 to 6 years without one case of relapse, transplant tissue all survived, and the original lesion Department are back to normal skin look better, repair, satisfactory results.ConclusionThe application of modern plastic surgery can effectively restore local wide excision of recurrent dermatofibrosarcoma protuberans after the larger wound defects, to prevent recurrence.

 Key words:dermatofibrosarcoma protuberan;eradicative resetion;reconstruction

 隆突性皮肤纤维肉瘤(dermatofibrosarcoma protub erans,DFSP)为皮肤真皮层的纤维组织细胞源性肿瘤,具有浸润性生长、远处转移少、恶性程度低、死亡率低等特点[1]。但单纯切除后的复发率高,且随着复发次数的增加,形态转化和恶性潜能增加[2],根治的关键在于充分认识此类肿瘤的特性,彻底切除病变和妥善地即时创面修复。笔者自1992年以来共收治了28例复发性DFSP患者,均进行了根治性切除和缺损创面的即时修复,术后经2～6年的随访,未见复发者,缺损修复效果满意。

 1临床资料

 1.1 一般材料:本组复发性DFSP患者28例,其中男性24例,女性4例,年龄32～55岁,平均38岁。首次复发者15例,再次复发者9例,第3次复发者3例,第4次复发者1例。每次复发间隔时间为15～25个月,平均18个月。肿瘤大小为4㎝×7.5㎝～14㎝×19㎝。病变部位:头部3例,前胸11例,腹部8例,腰背6例。本组均采用扩大切除用整形原则即时修复的手术方法,术后皮片、皮瓣全部成活。

 1.2 手术方法

 1.2.1 切除范围:首先详细确定DFSP病变范围,根据病变位置,在其周围>3㎝作梭形切口,注意无瘤操作及立体切除范围。对于切缘可疑的患者,术中做好定位标志, 行冷冻切片检查,若切缘阳性(手术切端镜下可见瘤细胞),在相应部位继续扩大切除至少1cm的边缘,直至切缘阴性。对于术后石蜡切片,切缘均要-进行详细组织病理学分析,对可疑切缘行CD34免疫组化染色,若发现阳性切缘,需重新切除或行其他治疗。

 1.2.2 切除深度:我们强调采用三维扩大切除(不但要注意肿瘤周边〔长和宽〕切除范围要足够,旁开3～5㎝,更要注意肿瘤切除的深度),根椐肿瘤浸润层次,对未侵及深筋膜层者,切除皮肤、皮下组织、筋膜至肌膜层;对侵及到深筋膜层者,切除包括其基底整层及肌肉层;对侵及至肌层者,连同肌肉及基底骨膜一并切除 ......