刘　伟　张海霞　刘瑞鸣　安　纲　归　来

[摘要]目的：探索头皮巨大神经纤维瘤切除术中减少出血及创面修复的方法。方法：2003年4月～2008年4月，应用瘤周肿胀技术配合皮肤软组织扩张术治疗头皮巨大神经纤维瘤8例。结果：8例患者均一次性完整切除瘤体，扩张皮瓣修复缺损创面。术中出血明显减少，出血量约100～300ml。随访3个月～1年，均未见肿瘤复发，扩张皮瓣成活良好。结论：瘤周肿胀技术配合扩张器技术可以较好地完成头皮巨大神经纤维瘤的完整切除及修复。

[关键词]神经纤维瘤；肿胀技术；皮肤软组织扩张术

[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2009）01-0154-03

Application of tumescent technique around neurofibroma with skin soft-tissue expansion technique in resection of gaint epicranium neurofibroma

LIU Wei, ZHANG Hai-xia, LIU Rui-ming, AN Gang, GUI Lai

(Department of Plastic Surgery, Qianfoshan Hospital of Shandong, Jinan 250014, Shandong, China)

Abstract:Objective To study the effective way to reduce the loss of blood and the method of repairing epicranium defect in resection of gaint epicranium neurofibroma.MethodsEight cases of gaint epicranium neurofibroma were resected using tumecent technique around neurofibroma and skin soft-tissue expansion technique from April 2003 to April 2008.ResultsThe epicranium neurofibromas of all the 8 cases were resected completely and the defections of epicranium were repaired with the expanded flaps. The loss of blood during operation reduced distinctly with amount from 100ml to 300ml. The follow-up period ranged from 3 monthes to 1 years. The expanded flaps survived well and no recurrence was found.ConclusionTumecent technique around neurofibroma with skin soft-tissue expansion technique can be used in resection of gaint epicranium neurofibroma.

Key words:neurofibroma; tumecent technique; skin soft-tissue expansion technique

头皮巨大神经纤维瘤手术切除术中出血多，切除后常形成巨大的皮肤软组织缺损，治疗困难。临床上需解决以下两个难题：①术中止血问题：瘤体内血管丰富，术中出血常难以控制；②术后创面修复问题：因瘤体较大，术后创面常难以直接闭合。2003年4月～2008年4月，我们应用瘤周肿胀技术配合皮肤软组织扩张术治疗头皮巨大神经纤维瘤8例，术中出血大大减少,扩张皮瓣修复创面，手术效果满意，报道如下。

1资料和方法

1.1 临床资料：2003年4月～2008年4月，我们应用瘤周肿胀技术配合皮肤软组织扩张术治疗头皮巨大神经纤维瘤8例，其中男1例，女7例，年龄18～33岁，平均21.6岁。瘤体15cm×12cm～25cm×20cm大小，瘤体表面头皮呈不同程度的灰褐色，局部头皮枯黄或花白。1例患者有神经纤维瘤病全身皮肤表现。均未发现家族史。

1.2 手术方法：Ⅰ期扩张期植入术。采用局麻或局麻＋基础麻醉。灰褐色瘤体外0.5cm处设计切口，在头皮帽状腱膜下植入皮肤软组织扩张器。……