手术治疗体表血管瘤及脉管畸形

目的 总结手术治疗体表血管瘤及脉管畸形的方法及临床疗效.方法 2003年5月-2006年12月,收治145例体表血管瘤及脉管畸形患者.男81例,女64例;年龄2个月～40岁,中位年龄17岁.病程2个月～40年.病变分布于头面部85例,四肢34例,躯干26例.病变范围为1 cm×1 cm～27 cm×24 cm.术中病变切除后直接缝合40例;采用3 cm×2 cm～18 cm×11 cm局部皮瓣移位修复21例,供瓣区直接缝合18例,腹部取皮回植3例;采用5 cm×3 cm～27 cm×18 cm中厚皮片移植84例,其中61例腹部供皮区直接缝合,5例大腿供皮区采用刃厚皮片游离移植修复,18例血管瘤病变区皮肤原位回植.结果 术后病理检查:毛细血管瘤38例,微静脉畸形23例,静脉畸形67例,动静脉畸形15例,淋巴管畸形2例.6例植皮患者术后发生皮片部分坏死,其中1例伴颅骨外露,经局部筋膜瓣移位修复联合植皮后愈合,5例经换药后Ⅱ期愈合;其余患者皮瓣及皮片均顺利成活,供受区切口均Ⅰ期愈合.患者均获随访,随访时间1～3年.12例于术后6个月～2年复发,其中动静脉畸形4例,静脉畸形7例,微静脉畸形1例,均再次手术切除后治愈.余患者伤口愈合良好,未见复发.结论 广泛彻底手术切除是治疗体表血管瘤及脉管畸形的有效方法之一,术后应密切随访有无病变复发,并及时对症处理.     

头皮脑回样病变畸形

目的提高对头皮脑回样病变畸形的认识和治疗水平。方法复习有关文献,对头皮脑回样病变畸形的病因、临床表现、诊断、分类和治疗进行了分析,采用切除后植皮或扩张头皮瓣修复治疗6例。结果6例病变切除彻底,随访无复发。其中2例植皮病例患者导致局部秃发,4例扩张头皮瓣修复外形满意。结论头皮脑回样病变畸形是一种罕见的头皮良性病变,头皮扩张术是修复治疗头皮脑回样病变的理想方法。     

成人头面部巨大血管畸形的手术治疗

目的：探讨成人头面部巨大血管畸形的手术切除与美容修复。方法：1998年9月以来，收治此类患者67例，占同期收治血管瘤与血管畸形患者的25．2％。术前通过CTA或MRI了解头面部血管畸形与颅内血管的关系；根据病变的部位、类型、范围选择不同的术式治疗，并于术中采用环状缝扎、电凝治疗、分区植皮等技术。结果：48例行大张中厚或全厚皮片移植修复创面者，皮片成活率≥95％，头部均遗留秃发畸形，面部术区外形基本满意；采用病灶切除＋（电凝治疗）＋直接缝合治疗的19例中，15例伤口发生不同程度创缘皮肤坏死，伤口裂开，其中3例行清创缝合术，12例经换药愈合；术后5个月～2年随访37例，27例效果满意，术区外形良好，局部无复发，10例局部有不同程度的复发，需二次手术治疗。结论：术前了解头面部血管畸形与颅内血管的关系至关重要；环状缝扎与电凝治疗有助于减少术中出血，简化切除难度，但电凝治疗对伤口愈合有一定影响；面部分区植皮有助于病灶切除后的美容修复。     

利用皮片移植及皮瓣转移修复会阴部烧伤后瘢痕挛缩畸形

目的:探讨修复烧伤后会阴部瘢痕挛缩畸形的手术方法。方法:对1990年以来收治的38例会阴部烧伤后瘢痕挛缩畸形患者行瘢痕切除松解,21例患者单纯中厚或全厚植皮,4例患者单纯局部皮瓣转移修复,13例患者皮瓣转移配合植皮修复。结果:1例皮瓣尖端2cm坏死,2例部分皮瓣色暗紫,2例植皮部分成活欠佳,经换药及对症处理痊愈,余均疗效满意。结论:皮片移植及皮瓣转移为治疗会阴部瘢痕挛缩畸形的较好手术方法。     

浅表血管瘤和脉管畸形的手术治疗

目的：评估手术切除方法对浅表血管瘤和脉管畸形的治疗效果。方法：对各部位位置表浅、界限清楚的血管瘤和静脉畸形、淋巴管畸形行手术切除,继发软组织缺损行直接缝合、局部皮瓣转移或植皮修复。结果：本组病例共91例,血管瘤56例,静脉畸形30例,淋巴管畸形5例;55例血管瘤1次手术切除,1例经2次手术切除;25例浅表静脉畸形1次手术切除,2例经2次手术切除,2例残余部分给予注射平阳霉素治愈;5例淋巴管畸形均1次手术切除。直接缝合63例,行局部皮瓣转移修复20例,植皮修复18例。随访时间分别为3个月～7年,所有病例均无复发,修复部位外形恢复良好。结论：对于诊断确切、界限清楚的浅表血管瘤和脉管畸形,手术切除是一种有效的治疗方法。     

皮肤软组织扩张术治疗头皮良性肿瘤术后缺损16例

目的 总结皮肤软组织扩张术治疗头皮良性肿瘤的疗效。方法 2000年1月～2005年9月，对16例头皮良性肿瘤患者，采用皮肤软组织扩张术治疗术后头皮缺损。其中男10例，女6例；年龄6～35岁。病程6～35年，平均21年。神经纤维瘤6例，血管瘤5例，头皮巨大黑色素细胞痣4例，毛细淋巴管瘤1例。14例接受1次软组织扩张术治疗，2例因病变巨大接受2次软组织扩张术治疗。扩张头皮瓣7．5cm×10．5cm～17cm×25cm。结果经1次皮肤软组织扩张术的患者，13例完全修复病变切除后残留创面，1例修复大部分创面，残留小部分非头发生长区，经植皮修复；经2次皮肤软组织扩张术的2例患者术后完全修复病变切除后残留创面。术后获随访6～12个月，无肿瘤复发，头发生长良好。结论 皮肤软组织扩张术是修复头皮巨大良性肿瘤切除后残留创面的主要方法之一。     

手部瘢痕挛缩畸形的手术治疗

目的：总结和探讨手部瘢痕挛缩畸形的手术治疗和临床效果。方法：1995年6月-2001年6月，我们对68例手部瘢痕挛缩进行手术治疗，彻底切除和松解瘢痕，应用皮瓣或植皮修复创面，其中皮瓣（包括Z成形）46例，植皮22例。结果：皮瓣组有2例出现皮瓣远端坏死；植皮组全部成活。60例病人获得随访，随访时间6个月-3年，再次发生瘢痕挛缩4例，均为植皮组；皮瓣组中有2例因外观臃肿而行整形术。病人手功能及外观较为满意，总优良率达78.3％。结论：选择适当手术时机、正确的修复方法及术后早期、有效的功能锻炼，是取得良好疗效的重要因素。     

缝扎结合肿胀技术用于头颈部动静脉畸形切除的疗效观察

目的 探讨采用缝扎结合肿胀技术替代头颈部体表动静脉畸形切除术前介入栓塞的可行性及效果。方法 2007年7月-2010年11月,收治头颈部体表动静脉畸形患者9例。男4例,女5例;年龄8个月~55岁,中位年龄21岁。先天畸形6例,外伤后诱发2例,原因不详1例。病变部位:额颞部2例,面颊部2例,枕颈部2例,颞顶部1例,上唇1例,下唇1例。动静脉畸形范围2.2 cm×1.2 cm~13.0 cm×10.0 cm。根据Schobinger分级:Ⅱ级8例,Ⅲ级1例。畸形涉及2~7条主要滋养动脉,滋养动脉直径1.7~3.1 mm。6例一期手术切除动静脉畸形直接缝合或植皮、局部皮瓣修复;3例一期皮肤扩张,二期手术切除动静脉畸形、扩张皮瓣修复。切除动静脉畸形前首先用7号丝线缝扎滋养动脉,病灶外周间断缝扎全层软组织2圈,病灶范围内肿胀液超量灌注。结果 术后除1例切口部分裂开,其余患者皮瓣、植皮均顺利成活,切口均Ⅰ期愈合。手术时间42~367 min,平均136 min;术中失血量15~1 000 mL,平均268 mL;术中输血1例,共输血3 U。患者均获随访,随访时间2年~6年6个月,平均4.2年。随访期间动静脉畸形无复发。患者自评外观满意或基本满意5例,可以接受4例。结论 缝扎结合肿胀技术操作简便,术中出血少,可以部分替代头颈部体表动静脉畸形切除术前介入栓塞。     

整形技术在修复头面部皮肤软组织缺损中的运用

目的总结运用整形技术修复头面部软组织缺损创面的临床经验。方法对86例头面部软组织缺损的患者,采用直接拉拢缝合12例,分次切除后直接拉拢缝合5例,皮肤软组织扩张法术11例,植皮术14例,邻近皮瓣转移加植皮联合修复术6例,邻近皮瓣转移修复术37例,吻合血管的游离大网膜＋游离皮片移植修复1例。结果扩张器外露1例;4例皮瓣远端小部分坏死,创面延期愈合;1例游离移植的大网膜坏死后重新植皮修复;移植的皮片小部分表皮坏死或水疱形成2例,换药后延期愈合,余均一期愈合。植皮成活率为85%-100%。24例随访3个月-10年：2例皮瓣蒂部“猫耳”再次手术矫正;3例植皮周边疤痕增生,经再次手术后平整;3例死亡（肺部转移2例,脑溢血1例）;16例功能、外形均满意,头发生长良好。结论头面部皮肤软组织缺损的修复方法应根据患者的具体情况灵活运用,尽量选用质地相配的组织。     

手术联合放射性~(125)I粒子植入治疗颈部及躯干部滑膜肉瘤

目的总结手术联合放射性125I粒子植入治疗颈部及躯干部滑膜肉瘤的疗效。方法 2010年5月-2012年5月,收治颈部及躯干部滑膜肉瘤患者4例。男3例,女1例;年龄33~68岁,平均50岁。病变位于颈后部、左颈根部、右腰背部和左肩胛下各1例。病变范围8 cm×6 cm×4 cm~12 cm×10 cm×6 cm。术中避开病变周围重要结构,尽量距病变周围2 cm以上彻底切除,病变切除区植入125I粒子并以皮瓣或肌皮瓣修复,供区植皮修复。结果术后患者皮瓣及植皮均成活,创面均Ⅰ期愈合。4例患者均获随访,随访时间18~36个月,平均26个月。皮瓣存活良好,局部均无肿瘤复发。其中1例于术后18个月因肺转移死亡。结论手术联合放射性125I粒子植入治疗颈部及躯干部滑膜肉瘤安全易行,可有效控制肿瘤局部复发。     

皮肤扩张术在面颊部增生型鲜红斑痣治疗中的应用

目的 探讨皮肤扩张术在面颊部增生型鲜红斑痣的应用效果.方法 应用面颈部扩张皮瓣修复面颊部增生型鲜红斑痣患者35例,包括单次扩张和重复扩张,并对睑外翻和睑缘葡萄酒色斑残留给予处理.结果 术后随访3～12个月(平均6个月),所有皮瓣均成活良好.5例后期扩张器外露,未影响皮瓣转移.9例因切口瘢痕行后期修整,结果满意.结论 面颈部皮肤扩张术是面颊部增厚型鲜红斑痣较理想的治疗方法.     

Treatment of Port Wine Stains with Intense Pulsed Light: A Prospective Study

BACKGROUND: Recent studies have shown that intense pulsed light can be useful in treating port wine stains that were resistant to previous pulsed dye laser therapy. Asian persons with high epidermal melanin context can be at a higher risk of complication. OBJECTIVE: The aim of this study was to conduct a prospective trial to assess the efficacy and complication of intense pulsed light in the treatment of port wine stains in Chinese patients. METHODS: Twenty-two Chinese patients with port wine stains without previous treatment were recruited to receive intense pulsed light source therapy for five to seven treatments at intervals of 3 to 4 weeks. Patient demographics, skin type, characteristics of port wine stains including color and location, treatment parameters, degree of pain caused by intense pulsed light treatment, percentage of clearing, and treatment complications were recorded and entered into a database. A questionnaire was conducted to assess the influence of treatment on daily activity and the intensity of pain experienced during treatment. RESULTS: There were 17 female and 5 male patients. Their ages ranged from 6 to 45 years with a mean age of 21.8+/-10.1 years. More than 90% of patients had more than 25% of clearing and the majority of patients (50%) had 25% to 50% of clearing. Although 40% of the patients showed more than 50% clinical clearance, 9% of the patients were able to achieve more than 75% clearing. The only 2 patients with less than 25% clearing had nodular port wine stains and no patient was able to achieve complete clearing. The procedures were well tolerated with a mean pain score of 2.1+/-0.9 and the treatment had no influence on daily activity. One patient developed blisters and 6 patients had swelling for more than 24 hr that all resolved within 1 week without leaving permanent marks. They have been followed up from 12 to 27 months and there was no long-term complication. CONCLUSION: Intense pulsed light can be effective in treating port wine stains in Asian patients. In experienced hands, complications can be low and should be considered as one of the therapeutic options.     

The role of the Lumina intense pulsed light system in the treatment of port wine stains--a case controlled study.

The pulsed dye laser has been the treatment of choice for port wine stains over the past 20 years. In the past 5 years there has been increasing discussion of the role of other light treatments, such as the intense pulsed light system in the treatment of port wine stains. These systems use high-energy lamps, which emit noncoherent broad-spectrum light. Cut off filters are applied depending on the treatment modality to limit the wavelengths emitted. We present the results of a 3-year prospective within patient controlled clinical trial using an intense pulsed light system called the Lumina, developed by Lynton Lasers of Cheshire, England. Our aims and objectives were to assess the effectiveness of the system in the treatment of port wine stains in a human model and to record the optimum treatment parameters and the incidence of side effects. Following ethical approval 12 subjects were enrolled into the trial. In order to meet the requirements of the local ethics committee these were all adults with port wine stains located in less visible areas of the body. The results showed that eight of the 12 subjects had some degree of fading of their port wine stain as measured on a percentage scoring system. Of the four who failed to show any response, all had pink port wine stains. It did seem the case that the darker the port wine stain, the better the fading seen. Furthermore, the more distal lesions tended to be less responsive than those situated closer to the head area. However, it is difficult to draw any definitive statistical conclusions due to the small number of patients in the trial.     

一期手术治疗下肢静脉曲张并发小腿慢性溃疡

目的 一期手术治疗下肢静脉曲张并发小腿慢性溃疡的回顾性临床分析。方法 １９９０年９月～１９９８年６月对５１例下肢静脉曲张并发小腿慢性溃疡一期施行下、小隐静脉高位结扎、剥脱和即刻溃疡创面清创、游离皮片植皮术。结果 ５１例术后移植皮片全部成活５０例,１例移植皮片部分坏死,经换药愈合。４２例获得１６个月～９年（平均６６个月）随访,３９例下肢静脉曲张和溃疡未复发,湿疹痊愈合疗效满意;３例溃疡复发,但未见下     

头面部皮肤恶性肿瘤手术切除及创面修复与重建的方法探讨

目的：探讨头面部皮肤恶性肿瘤手术切除及创面修复和重建的临床经验。方法：对2006年9月～2011年3月共收治的38例头面部皮肤恶性肿瘤患者进行回顾性分析,术后创面根据患者情况分别采用人工脱细胞异体真皮（MATRIDERM）移植10例、原位缝合8例、皮片和人工脱细胞异体真皮（MATRIDERM）联合移植4例,皮片移植2例、局部皮瓣6例、邻位皮瓣5例进行修复和重建。结果：本组38例,除1例人工脱细胞异体真皮（MATRIDER）M移植创面边缘感染经换药治疗伤口II期愈合外,其余皮瓣和值皮均成活,供区和人工脱细胞异体真皮（MATRIDER）M移植创面均I期愈合。32例患者获随访1～3年,1例复发,复发病例为植皮治疗的鳞状细胞癌患者于术后2年复发,经再次手术扩大切除后采用皮瓣移位修复,随访1年未再复发;随访患者均存活良好,外形及功能满意。结论：头面部皮肤恶性肿瘤早期诊断、彻底切除、及时修复,杜绝复发及取得良好的外观和功能效果是治疗的关键所在,修复方法根据患者具体情况和头面部美学单位或亚单位原理遵循由简至繁的原则,尽可能兼顾缺损区域外形和功能的修复和重建。     

超脉冲CO_2点阵激光治疗微静脉畸形64例疗效观察

目的：观察运用超脉冲CO2点阵激光治疗微静脉畸形的临床疗效。方法：回顾性分析近年来使用超脉冲CO2点阵激光治疗的64例微静脉畸形患者病例资料。结果：64例微静脉畸形患者,经1～5次治疗,治愈28例,显效24例,有效9例,无效3例,总有效率81.2%。结论：超脉冲CO2点阵激光治疗微静脉畸形疗效较好。     

双波长（595nm和1064nm）脉冲激光治疗血管性皮肤病429例

目的：观察595nm和1064nm双波长脉冲激光治疗血管瘤、微静脉畸形、蜘蛛痣、毛细血管扩张的临床疗效及影响疗效的因素。方法：总结双波长595nm和1064nm激光器治疗血管性皮肤病患者的资料429例,评价其疗效和安全性,比较不同类型血管性皮肤病的治疗参数、治疗次数及相关影响因素。结果：治疗的总有效率为94．2％,血管瘤愈显率为63．6％,微静脉畸形52．7％,随着治疗次数增多,两者有效率达94．8％、91．9％;蜘蛛痣有效率为100％,毛细血管扩张症为80％。蜘蛛痣所需治疗次数最少,治疗参数较高;微静脉畸形需4次以上治疗才能达到较好疗效,所有血管性皮肤病治疗间隔3～5周时疗效显著。结论：双波长激光治疗血管性皮肤病安全、有效,其中蜘蛛痣和血管瘤疗效好,且治疗次数少,疗程短,不良反应发生率低。微静脉畸形需多次治疗,毛细血管扩张症选择双波长激光联合IPL治疗更好。     

Reactivity of the microcirculation in port wine stain hemangiomas evaluated by laser Doppler fluxmetry

Twelve patients with port wine stains (both untreated and treated with argon laser) had their microcirculation monitored by laser Doppler flux at rest and after arterial occlusion lasting one minute. The blood cell flux was measured in normal, untreated and treated skin areas. The resting flux was significantly higher in untreated port wine stains than in the normal skin. The reactive hyperemia response was significantly impaired in the untreated skin, although a 60% increase in blood cell flux was achieved by the short arterial occlusion. In most of the recorded parameters the treated areas showed a less pathological reaction than the untreated ones. We conclude that peroperative vasodilation can be induced in port wine stains, and this may be used to improve the outcome of argon laser treatment.     

新生儿红斑的自然病程及其与葡萄酒色斑的鉴别研究诊断

目的探索新生儿红斑的自然病程,及其与葡萄酒色斑的鉴别要点。方法对2007年3月至2011年5月,来我科就诊的36例面颈部红斑患儿进行随访,观察红斑的发生特点及转归,分析并总结新生儿红斑与葡萄酒色斑的鉴别诊断依据。结果本组36例患儿中,诊断为新生儿红斑21例,多部位累及者15例(71.4%),其中累及前额及眉间者有16例(38.1%)、项部有13例(31.0%)、眼睑有9例(21.4%)、人中有3例(7.1%)。随访至2岁时,18例消退或减淡(85.7%);其余3例随访至5岁,红斑无减退倾向,遂诊断为葡萄酒色斑。本组中另15例患者诊断为葡萄酒色斑,其中颞区2例(13.3%),面颊区8例(53.3%),下颌区3例(20%),多区累及者2例(13.3%)。随访至2岁时,90%患儿无明显改变,其余2例有轻微加深。结论新生儿红斑与葡萄酒色斑在形态学上具有相似性,但两者发生部位及自然病程存在明显差异。当难以鉴别时,加强随访是减少误诊及防止错误治疗的重要手段。     

Robotized scanning laser handpiece for the treatment of port wine stains and other angiodysplasias

Port wine stains are currently treated by the argon laser with the "point-by-point" technique, or the "painting technique." In both cases, the quality of the results depends greatly on the dermatologist's experience. Furthermore, the first technique is slow, and the second is painful and requires anesthesia. Therefore, we have decided to design a robotized system with the following specifications: easy, fast, non-painful treatment giving a homogeneous and reproducible blanching. The system is made of a handpiece with the scanning mechanism and a control box with the microprocessor. The system is independent of the laser (no electrical connection) and has its own power meter. The deposit of energy was optimized in function of heat diffusion in the skin. Over a 12-month period, 123 patients were treated with the robotized handpiece. The treatment modalities and the results conformed to the above-mentioned specifications. Hypertrophic scars were not reported. Therefore, we think that this system will be an interesting tool for the laser treatment of port wine stains and other cutaneous angiodysplasias.