皮肤色素痣不同治疗方法疗效分析比较

目的：比较冷冻、激光及手术治疗皮肤色素痣的疗效及美容效果。方法：皮肤色素痣患者4682例,分为三组：液氮冷冻组600例,用手持式冷冻刀或医用棉签行液氮冷冻治疗;激光组1882例,分别用超脉冲CO2激光和Q开关翠绿宝石激光治疗;手术组2200例,采用切除缝合或切除后邻近皮瓣修复。治疗后对疗效及副作用进行评价。结果：液氮、激光治疗较表浅的色素痣和雀斑样痣疗效较好,对皮内痣及混合痣疗效差且易产生瘢痕;手术切除缝合可治疗各种类型的色素痣,治疗次数少、术后不良反应少并且无明显切口瘢痕。结论：皮肤色素痣治疗应首选手术切除,同时术后应行组织病理学检查。对于较表浅的色素痣和雀斑样痣可选择冷冻和激光治疗,皮内痣和复合痣不宜采用冷冻和激光治疗。     

色素痣426例组织病理及手术疗效分析

分析色素痣组织病理结果及观察色素痣美容手术治疗效果。方法：对就诊于西京医院皮肤科接受美容手术治疗的色素痣患者进行组织病理分析，门诊及电话随访疗效。结果：色素痣患者共426例，男性175例，占41.08％，女性251例，占58.92％。组织病理结果：皮内痣87.79％，交界痣0.93％；混合痣6.82％；蓝痣4.46％；术后3月、6月、1年、3年门诊及电话随访，患者对于治疗的满意率分别为91.8％、94.3％、97.3％、97.7％，无1例复发。结论：色素痣手术治疗效果最佳，建议常规送组织病理检查。     

手术治疗面部皮肤色素痣的临床应用

目的：探讨手术治疗面部皮肤色素痣的临床应用方法和效果。方法：应用直接切除缝合、皮瓣转移、软组织扩张、游离皮片移植等方法手术治疗面部皮肤色素痣。结果：自2006年以来完成手术126例,患者面部皮肤色素痣均得到较好整复。结论：根据面部皮肤色素痣的部位和大小采取不同的手术方式,临床应用效果良好,可临床推广应用。     

高频电刀、CO2 激光及手术切除精细缝合治疗皮肤色素痣的效果比较

目的 比较高频电刀、CO2激光及手术切除精细缝合3种治疗方式在皮肤色素痣患者中的应用效 果。方法 选取旬阳市人民医院皮肤科2019年7月-2022年7月收治的360例皮肤色素痣患者为研究对象，根 据治疗方法不同分为A组（n =113）、B组（n =120）、C组（n =127）。A组接受高频电刀治疗，B组接受 CO2激光治疗，C组接受手术切除精细缝合治疗，比较三组临床疗效及不良反应发生情况。结果 C组治疗 总有效率为97.64%，高于A组的82.30%，B组的85.83%，差异有统计学意义（P ＜0.05）；C组不良反应发生 率为1.57%，低于A组的12.39%，B组的10.00%，差异有统计学意义（P ＜0.05）。结论 高频电刀、CO2激光 及手术切除精细缝合治疗皮肤色素痣的效果均良好，但相比于高频电刀、CO2激光治疗，手术切除精细缝 合治疗的有效性及安全性更佳，可作为临床治疗皮肤色素痣的首选。     

色素痣分次切除术治疗疗效观察

目的：探讨分次切除色素痣的临床效果。方法：根据痣的部位、大小及美容要求,采用分次手术的方法切除351例患者的378个皮损。结果：色素痣分次切除术后外观基本正常,均无感染、无复发、周围器官无牵拉变形,总体效果良好。结论：分次切除治疗色素痣具有临床应用的普及性和良好美容结果,值得临床推广。     

鱼嘴形切口在色素痣分次手术切除中的临床应用

目的:探讨鱼嘴形切口在色素痣分次手术切除中的临床应用效果。方法:对30例中小面积色素痣患者采用鱼嘴形切口进行分次切除治疗,每次间隔3～6个月,切除至皮损缩小到能够直接切除缝合。结果:本组30例色素痣患者采用鱼嘴形切口分次切除治疗后,术区切口均一期愈合,无并发症发生,随访6～18个月,无复发,皮损周围组织无明显牵拉变形现象,最终术区瘢痕不明显,视觉效果良好,医师与患者均对治疗后效果满意。结论:鱼嘴形切口在色素痣的分次切除中克服了传统梭形切口长宽比较大的缺陷,增加了皮损单次切除面积,减少了手术总治疗次数,操作方法相对简单,值得临床推广应用。     

睑缘痣切除术临床研究

目的：研究可达较好的美学效果的睑缘痣切除方法。方法：采用皮肤“Z”形和睑结膜“V”形的手术设计，切除睑缘痣。结果：18例患者均取得了良好的美容手术效果。结论：“Z”形皮肤切口设计可以防止因睑缘痣切除所致的切迹，是一种符合整形美容原则的术式。     

颜面部皮肤色素痣的治疗体会

目的：探讨颜面部色素痣的治疗方法。方法：用高频电灼法、Q开关Nd：YAG激光、手术切除缝合术治疗颜面部色素痣。结果：高频电灼法易遗留凹陷性瘢痕，Q开关Nd：YAG激光治疗后无瘢痕，无色素沉着及脱失，但治疗周期长，反复刺激有恶变可能；手术切除法彻底，面积大者分次切除有线状瘢痕。结论：高频电灼法不适用治疗颜面部色素痣，直径在5mm以下者色素痣首选Nd：YAG激光，直径在5mm以上或有恶变体征者选择手术切除。     

环钻切除法在面部点圆状皮肤病变治疗中的应用

体表较大的点圆状皮肤痫变，尤其是位于面部的色素痣、小肿物、小瘢痕，对美容有较显著的影响。传统的方法一般采用切除缝合，但因其遗留比原病变直径长出约一倍左右的线状瘢痕，且需缝合、拆线及缝合后所引起的皮肤牵拉或瘢痕挛缩又可造成周围组织变形等不足，所以临床难以推广。自1998年以来，笔者对面部多种点圆状皮肤病变采用环钻切除的方法，不作创面缝合，依靠创缘的自然收缩愈合，临床治疗380例患者，效果良好，现报道如下。     

多次切除环扎缝合治疗较大瘢痕及色素痣

临床上治疗面积较大的皮肤瘢痕及色素痣，多以分次切除或切除后植皮方法治疗，瘢痕较长，或衔皮区周缘瘢痕较明显，影响美观，应用多次切除环扎缝合法可使创面缩小到较小范围，达到与皮肤纹理一致的线状缝合，效果满意。     

环钻切除加湿润法在治疗头面部点圆状皮肤病变中的研究应用

目的：探讨一种新的治疗头面部点圆状皮肤病变的方法.方法：将环钻套置于病变周边,垂直切透皮肤全层,将病变提起,在真皮下剪除病变组织、压迫止血后,创面涂满湿润烧伤膏,不缝合及包扎,依靠创缘的自然收缩愈合.结果：患者1100例,共计皮损3 000个.病变直径为2～5mm的1 700个皮损创面,术后7天全部愈合;直径为6～10mm的800个皮损,术后15天愈合730个（占91.3%）,其余20天后愈合;直径为11～1 5mm的皮损500个,术后3周愈合380个（占76.0%）,其余术后5周愈合.结论：环钻切除加湿润法治疗头面部直径在10mm以下的点圆状皮肤病变是一种操作简便、创伤轻微、并发症少、经济安全、效果良好的新方法,尤其适合于治疗眉、眼睑、内外眦、口唇、鼻翼、鼻唇沟等部位的皮肤病变,值得临床推广应用.     

部分切除结合皮肤扩张术快速治疗体表大面积色素痣

目的探讨部分切除结合皮肤扩张术,快速治疗体表大面积色素痣的临床应用价值。方法应用部分切除结合皮肤扩张术,两期法快速治疗11例体表大面积色素痣患者(面积7.0 cm×5.0 cm~35.0 cm×22.0 cm)。术后随访12~24个月评价疗效。结果 10例患者顺利完成整个治疗过程,最短治疗时间4周,最长9周,平均6周。1例因扩张器皮下血肿中止治疗。随访12~24个月,效果满意。结论部分切除结合皮肤扩张术是快速治疗体表大面积色素痣较好的方法。     

改良真皮帽双环法乳房悬吊术

目的：总结改良真皮帽双环法乳房悬吊术的临床经验。方法：采用传统的双环法乳房悬吊术切口,但在其深部皮下组织深面剥离时,保留乳晕深部组织的完整,形成真皮帽,外环以外组织在皮下组织深面、乳腺腺体表面进行剥离直至乳房周围基底部,将乳腺腺体下极内翻缝合,并将去表皮的真皮脂肪帽向乳腺基底部牵拉缝合固定塑型,采用单股涤沦线荷包拉拢缩小外环皮肤切口,5—0单股尼龙美容线缝合内外环皮肤切口,术后乳房塑型包扎。结果：术后随访乳晕周围皮肤皱褶两个多月之后基本消失,患者对术后乳房外形比较满意。结论：改良真皮帽双环法乳房悬吊术对于矫正轻度和中座乳房下垂是一种比较理想的方法。     

Longitudinal melanic nail bands (melanonychia): report of 22 cases

INTRODUCTION: Longitudinal melanonychia is a diagnostic and treatment problem for the surgeon. Fear of melanoma most frequently leads to total excision of nail bed, matrix and plate. METHOD: Twenty two patients, aged from 7 to 77, were operated on from 89 to 98 in our department, using different techniques (total matrix biopsy, total excision of melanonichia with direct suture, Schernberg flap). RESULTS: Thumb and index are predominant locations (11 out of 16). No malignant lesions were found histologically. Aesthetic sequellae were frequent and directly linked to the width and location of the melanonychia. Limited matrix biopsy produce the best aesthetic result. DISCUSSION: Malignant lesions are rare and our series is short. Therefore an additional multicentric study is required. Our choice is to make a limited matrix biopsy in the first place with a minimal aesthetic prejudice. Histology determines the treatment choice: excision or follow up.     

Gynecomastia Treatment with Subareolar Glandular Pedicle

BACKGROUND: Gynecomastia is enlargement of the male breast. Although treatment is not indicated in most cases, aesthetic reconstructive surgery is commonly performed for psychological reasons. The goals in surgical treatment are to restore the breast contour with minimal scar and to protect areolar anatomy and sensation. This clinical study investigates the results of the subareolar glandular pedicle technique, in which the pedicle is dissected 2 mm wider than the areola with a circumareolar incision and the breast tissue is excised en bloc. The technique differs from the classical circumareolar approach with its thinner pedicle and excision of the breast without leaving prepectoral tissue. METHODS: We operated on nine patients with grades 1 and 2 gynecomastia using the subareolar glandular pedicle. Exposure was excellent with the circumareolar incision. Neither hematoma nor seroma formation was seen in any of the patients. Partial areola necrosis, which caused suture separation, was the only early postoperative complication seen, and this in a patient who smoked heavily. Patients were followed for at least 6 months. RESULTS: Eight patients achieved a good aesthetic contour of the chest, and one patient needed a contour revision for the residual mass because of a bulky pedicle. Circumareolar scars were satisfactory for all the patients, including the patient with partial areola necrosis. Circumareolar hyperpigmentation developed in one patient, and areola sensation was preserved in seven patients. CONCLUSIONS: The subareolar glandular pedicle is indicated for grades 1 and 2 gynecomastia. Circumareolar incision provides perfect exposure. The technique is reliable if the pedicle is dissected 2 mm wider than the areola and dissection under the pedicle is avoided. Postoperative circumareolar scarring is minimal and nipple-areola sensation is preserved in most cases. However, experience is needed to determine the pedicle girth because a wide pedicle leads to subareolar bulk, whereas a thin pedicle may cause partial areola necrosis.     

改良微小单孔腹腔镜下细针带线行小儿疝高位结扎的体会

目的探讨改良微小单孔腹腔镜下细针带线高位结扎治疗小儿疝的疗效。方法患者全身麻醉后,在脐下穿刺建立气腹,置入5mm微型腹腔镜,探查患侧疝环位置和大小,并观察对侧有无隐性疝,于患侧内环口体表投影处切开2mm切口,尖端带线穿刺针由此在腹膜外绕内环口行半荷包潜行穿刺,并在腹腔内留一线圈后退针;同一方法做另一个半荷包潜行穿刺,用第二根线将第一根线的线圈拉出体外,使之在内环口形成一个完整的荷包,缩紧,皮下打结。若有对侧疝则按相同方法处理。结果本组26例病例均顺利完成,2例嵌顿疝在麻醉后镜下探查1例为肠管,另1例为网膜,在手法复位协助下均顺利还纳,镜下观察5min血运良好。第1～3例手术时间单侧疝32～68min,平均52min;双侧疝80min。第4～10例手术时间单侧疝15～45min,平均34min;双侧疝40min。第11～26例手术时间单侧疝10～20min,平均12min;双侧疝18min。麻醉清醒后可进食,患儿能耐受疼痛。术后平均48h可出院,术后无切口感染、血肿形成,无阴囊水肿。随访3～18个月,无复发,无其他并发症发生。结论改良微小单孔腹腔镜高位结扎治疗小儿疝不破坏腹股沟管的解剖结构,安全、简单、创伤轻微。     

应用削除及磨削法治疗体表先天性巨痣疗效分析

目的探索应用削除或磨削法治疗成人体表先天性巨痣的操作与效果。方法综合先期进行的病理学检查结果、病变具体位置及患者的治疗心理预期等相关因素后,使用滚轴取皮刀切取刃厚或中厚皮片,或者使用高速的“西瓜”磨头磨削肿物浅层病变的方法治疗巨痣,治疗区保持在湿润状态下愈合,治疗按部位分1～2次进行,共治疗10例。结果10例中5例患者取得较为理想的效果,肤色接近正常,病理学检查未发现痣细胞明显残留,4例明显改善,1例有所复发,多数治疗效果均达到患者的心理预期。结论削除或磨削法对曾用其他方法治疗效果不佳或须付出较大代价的体表先天性巨痣有明显的实用效果,特别是由于综合考虑了多种相关因素,有利于在治疗效果与治疗代价之间取得较好的平衡,值得在临床上加以推广。     

Congenital giant nevocellular nevus of the back with deep extension to the fat and fascia

The presence of deep pigmentation in a giant congenital nevus makes its complete removal very difficult and should be taken into consideration when planning for treatment. A clinical case in which the pigmented lesion was found to extend deep into the muscle fascia is described. The lesion was surgically removed with an acceptable functional and aesthetic result through the utilization of tissue expansion. The development of new surgical techniques and the expansion of laser technology will possibly provide new treatment options in the future. Emphasis should be placed on aesthetics and function, because the excision based only on oncological anticipation is no longer valid. The presence of deep pigmentation makes certain treatment options less effective than surgical ablation.     

Aesthetic Results of Treatment of Large Alopecia with Total Scalp Expansion

In the last 7 years, 18 patients with large alopecia (approximately one-third of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 44 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience gained with these cases led us to make some modifications in the surgical technique. We applied some simple surgical maneuvers and Z-plasties to the last 18 cases with large alopecia. The major complication rate of 3.2% observed in this study is comparable to the lower complication rates of 6–12% reported in the literature for different degrees of alopecia. We believe that these simple modifications and meticulous approach improve the results of conventional treatment of alopecia with tissue expansion and flap. In this paper, details of the insertion technique and reconstructive procedures and their relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.