陈永军　唐银科　孙峰　马显杰

[摘要]目的：探讨分次切除术在色素痣治疗中的临床应用价值。方法：选取2016年1月-2019年4月笔者医院行色素痣分次切除术的住院患者共56例，总共58个色素痣，根据色素痣的大小、形态分2～3次手术治疗，观察其疗效，探讨色素痣分次切除术的适应证、手术技巧和术后护理注意事项。结果：1例患者术后出现伤口裂开，2例患者出现瘢痕增生，其余53例术后恢复良好，瘢痕不明显，外观满意。结论：色素痣分次切除术是一种简单有效的手术方式，如果准确把握手术适应证，应用整形美容外科技术，可获得良好的治疗效果，值得临床推广应用。

[关键词]色素痣;分次切除术;整形美容技术;瘢痕

[中图分类号]R758.5+1    [文献标志码]A    [文章编号]1008-6455（2020）08-0069-03

Clinical Effect of Staged Excision in Treatment of Melanocytic Nevus

CHEN Yong-jun，TANG Yin-ke，SUN Feng，MA Xian-jie

（Department of Plastic Surgery，the First Affilited Hospital of Air Force Medical University，Xi'an 710032，Shaanxi，China）

Abstract： Objective  To demonstrate the value of the clinical application of staged excision in treatment of melanocytic nevus. Methods  56 inpatients with 58 melanocytic nevus underwent staged excision from January 2016 to April 2019 in our hospital. Twice or 3 times of surgery were taken according to the size and shape of the nevus. The effect of the treatment was evaluated， and the indication of staged excision， surgical technique and postoperative nursing were explored. Results  Postoperative wound dehiscence was observed in one case， and scar hyperplasia was observed in 2 cases. The rest of the 53 cases obtained a satisfactory appearance without obvious scar. Conclusion  Staged excision is a simple and effective way in the treatment of melanocytic nevus. If the patient has been chosen correctly， it can receive favorable therapeutic outcome with plastic surgical technique. Serial excision should be widely applied in clinic in the future.

Key words： melanocytic nevus; staged excision; plastic surgical technique; scar

色素痣（即黑素细胞痣）是一种整形外科常见疾病，可发生于人体任何部位，发生于颜面部等暴露部位的色素痣有碍美观，影响患者心理和生活质量，且色素痣有一定的恶变率[1]。除了面积较小的（小于3mm）色素痣可用诸如激光、冷冻、化学剥脱等非手术疗法外[2]，色素痣的治疗常需要手术切除。常用的手术方式有直接切除、分次切除、切除后植皮或皮瓣修复等[3]。对于稍大的色素痣，一次切除缝合张力可能较大，后期瘢痕较明显或可能引起临近组织器官的变形或移位，对于这种情况，可采用分次切除。分次切除是整形外科的经典术式，通过几次小范围切除使色素痣逐步缩小，最终仅形成线性瘢痕。手术操作相对简单，易掌握，创伤小。……