郎中亮　钟晓红　汪凯　赵李平　汪洪源　王明刚　褚燕军

[摘要]目的：探讨负压创面治疗技术在恶性黑素瘤腹股沟淋巴结清扫术中的应用价值。方法：回顾分析2002年1月-2018年12月就诊笔者医院整形外科并接受了腹股沟淋巴结清扫的恶性黑素瘤患者。纳入患者按照是否联合使用负压创面治疗技术，被分为负压创面治疗技术组和传统治疗组。对比两组患者的一般资料、术后愈合时间及并发症发生情况。结果：63例患者被纳入本研究，其中负压创面治疗技术组30例，传统治疗组33例。两组患者一般资料比较差异无统计学意义（P>0.05）。负压创面治疗技术组术后愈合时间明显短于传统治疗组，并且降低了感染（3.3% vs 24.2%）、延迟愈合（16.7% vs 42.4%）、皮下积液或血肿（3.3% vs 30.3%）、淋巴漏（6.7% vs 27.3%）的发生率，差异具有统计学意义（P<0.05）。结论：恶性黑素瘤腹股沟淋巴结清扫联合负压创面治疗技术，可以有效地缩短术后恢复时间，降低术后并发症发生率，值得临床上推广。

[关键词]负压创面治疗技术;恶性黑素瘤;腹股沟淋巴结清扫;愈合时间;并发症

[中图分类号]R739.5    [文献标志码]A    [文章编号]1008-6455（2020）08-0072-04

The Effect of Negative Pressure Wound Treatment in Inguinal Lymph Node Dissection for Malignant Melanoma

LANG Zhong-liang，ZHONG Xiao-hong，WANG Kai，ZHAO Li-ping，WANG Hong-yuan，

WANG Ming-gang，CHU Yan-jun

（Department of Plastic Surgery，the First Affiliated Hospital of USTC，Anhui Provincial Hospital，Hefei 230001，Anhui，China）

Abstract： Objective  To investigate the effect of negative pressure wound therapy（NPWT） in inguinal lymph node dissection（LND） in malignant melanoma（MM）. Methods  The patients with MM who received inguinal LND in our hospital were analyzed retrospectively， from January 2002 to December 2018. The enrolled patients were divided into the NPWT group and the traditional treatment group according to whether the NPWT was used. The general data， postoperative healing time and complications were compared between the two groups of patients. Results  63 patients were included in this study， including 30 patients in the NPWT group and 33 patients in the traditional treatment group. There was no significant difference in general data between the two groups（P>0.05）. The healing time of the NPWT group was significantly shorter than that of the traditional treatment group， the difference was statistically significant（P<0.05）. The incidence of infection （3.3% vs 24.2%）， delayed healing （16.7% vs 42.4%）， subcutaneous effusion or hematoma （3.3% vs 30.3%） and lymphatic leakage （6.7% vs 27.3%） in the NPWT group were lower than those in the control group（（P<0.05）. Conclusion  The treatment of MM with inguinal LND combined with NPWT can effectively shorten the postoperative healing time and reduce the incidence of postoperative complications， so it is worth popularizing.

Key words： negative pressure wound therapy; malignant melanoma; inguinal lymph node dissection; healing time; complications

恶性黑素瘤（Malignant melanoma，MM）轉移率高、预后差，是致死率最高的皮肤肿瘤，近来我国MM发病率和死亡率都在逐年增长。我国MM主要原发于肢端皮肤（如足底、手掌、甲下等），一项大样本的研究发现我国原发于掌跖和四肢的MM约占总体50%，并且我国MM患者确诊时病期绝大多数处于Ⅱ期（58.3%）和Ⅲ期（25.2%）[1]。为了改善预后，这些患者往往需要行腹股沟或者腋窝淋巴结清扫（Lymph node dissection，LND）[2]。其中腹股沟LND术后并发症发生率高，包括创面感染、切口裂开、皮瓣坏死、淋巴漏等。既往有很多种方法用以减少MM患者腹股沟LND的并发症，如缝匠肌转位法、保留大隐静脉法、术中使用血纤蛋白粘合剂等，但最近的研究发现上述方法均无明显的效果[3]。有研……