手术治疗面部皮肤恶性肿瘤

目的　探讨面部皮肤恶性肿瘤的手术及修复的临床经验。方法 2000年1月至2006年12月，收治面部皮肤恶性肿瘤65例，其中基底细胞上皮瘤47例，鳞状细胞癌10例，隆突性皮肤纤维肉瘤3例，恶性黑素瘤2例，棘皮瘤恶变、血管内皮肉瘤、皮脂腺癌各1例，均予扩大切除，术中作冰冻切片监测手术切缘及基底，分别采用直接缝合、邻位随意皮瓣、扩张皮瓣、游离皮片移植修复。结果 65例患者均一期修复，皮片和皮瓣100%存活，术区外形和功能满意。随访6个月至5年，基底细胞上皮瘤局部复发1例；鳞状细胞癌1例颈部淋巴结转移，1例局部复发；恶性黑素瘤1例去世，余无局部复发和转移。结论 彻底切除面部皮肤恶性肿瘤是预防术后复发的关键。适宜的修复有助于容貌恢复，其中以邻位随意皮瓣的效果较好。

Surgical management of facial malignant tumors

Objective To investigate the performance of surgical management in facial skin malignancies. Methods From January 2000 to December 2006, 65 patients with facial skin malignancies, including 47 cases of basal cell carcinoma, 10 cases of squamous cell carcinoma, 3 cases of dermatofibrosarocoma protuberans, 2 cases of malignant melanomas, and one case of malignant acanthoma, hemangioendotheliosarcoma and sebaceous carcinoma, respectively, were collected and managed with wide resection followed by reconstruction. In order to achieve a thorough resection, frozen sections were prepared and subjected to pathological examination during the operation process to ensure the margins of resection were free of malignancy. Reconstruction was carried out by direct closure, or with local random flaps, extended flaps, free skin grafts. Results All defects were managed by one-stage reconstruction. The survival rate of skin flaps/grafts was 100%, and a satisfactory appearance and function was achieved. During the follow-up from 6 months to 5 years, local relapse was observed in one patient with basal cell carcinoma and one with squamous cell carcinoma, lymphatic metastasis in one with squamous cell carcinoma. Distant metastasis occurred in a patient with malignant melanoma, who died consequently. Conclusions Thorough resection is the key to prevent relapse of facial skin malignancies after surgery. Appropriate reconstruction may favor the restoration of facial appearance, and local random flaps appear to be the best reconstruction strategy.