外鼻恶性肿瘤的精准切除及缺损修复

目的:探讨精准切除外鼻恶性肿瘤以及准确评估、合理修复组织缺损的方法。方法:回顾性分析解放军联勤保障部队第九八〇医院2010年1月至2020年6月期间收治的48例外鼻恶性肿瘤患者，其中男性28例，女性20例，年龄36~86岁。肿瘤病理类型包括基底细胞癌29例，鳞状细胞癌11例，外毛根鞘癌6例，腺样囊性癌1例，非霍奇金淋巴...

Precise resection and defect repair of external nose malignant tumor

Objective To explore the methods for the accurate resection of malignant tumors of the external nose,and the accurate evaluation and repair of tissue defects.Methods We collected 48 cases with nasal malignant tumors treated in 980 Hospital,Joint Support Force of the People's Liberation Army from January 2010 to June 2020,including 28 males and 20 females,aged 36-86 years.The pathological types of tumors included basal cell carcinomas(n=29),squamous cell carcinomas(n=11),trichilemmal carcinomas(n=6),denoid cystic carcinoma(n=1)and non-Hodgkin lymphoma(n=1).Tumor resection was mainly based on the traditional extended resection determined by the safety margin,and Mohs surgery was used to minimize the scope of resection,for the margin that significantly affected the repairing results,such as the lesion adjacent to the nasal alar margin,nasal columella or deep easy-penetrating margin.All cases obtained tumor resection and primary/secondary defect reconstruction.Results According to the pathological type and tumor size,the safe resection margin was mainly 4-10 mm,and Mohs surgery was used in 24 cases.Limited-size defects in 38 cases were repaired with double-leaf flaps,kite flaps,nasal dorsum brow flaps,nasolabial flaps or free tissues.Among 10 cases with compound defects,8 cases were repaired with frontal flaps,including 4 cases with single frontal flaps,2 cases with additional titanium mesh stent reconstruction and 2 cases with over and out frontal flaps.During follow-up of 1 to 10 years,all the flaps survived without flap necrosis,and the postoperative nasal contour and ventilation were satisfactory.One patient had tumor recurrence 18 months after operation,2 patients died of cardiovascular and cerebrovascular diseases,and other patients survived without tumors.Conclusions Mohs surgery can basically meet the requirements for precise resection of external nasal malignant tumors.Individualized application of adjacent tissue flaps and various frontal flaps is a reasonable choice to achieve the satisfactory outcome of external nasal repair and to take into account the complexity of operation.