Mohs显微描记手术治疗头面部皮肤恶性肿瘤

摘要

Objective To investigate the effects and prognosis of Mohs surgery for treating craniofacial cutaneous malignant tumors,such as basal cell carcinoma (BCC),squamous cell carcinoma (SCC).Bowen's disease and actinic keratosis (AK) and analyze the clinical characteristics of craniofacial cutaneous malignant tumors.Methods Totally 411 cases of cutaneous malignant tumors without metastasis were enrolled,of which 256 cases were performed the Mohs microsurgery (group A),130 cases were performed surgical operation with the traditional intraoperative frozen-section examination (group B),25 cases were performed classic surgical operation (group C).Adjacent flap,myocutaneous flap,skin graft or direct suture was used to repair the wound.All were followed up for 3 to 5 years.Results In group A,248 cases were Ⅰ healing with skin flaps and skin grafts all survived;8 cases were Ⅱ healing,2 cases recurred (0.8％).In group B,125 cases were Ⅰ healing,5 cases were Ⅱ healing,7 cases recurred (5.4％).In group C,all cases were Ⅰ healing,4 cases recurred (16％).The recurrence rate was statistically differentanlong thro groups (P＜ 0.05).Conclusions Mohsmicrosurgery is the first choice to treat craniofacial cutaneous malignant tumors,which can resect tumor completely,at the same time reserve the normal skin tissues to the greatest extent and reduce the excessive damage to patients’ appearance by operation.%目的 探讨Mohs显微描记手术治疗头面部基底细胞癌、鳞状细胞癌及鲍温病等皮肤恶性肿瘤的疗效和预后,分析头面部皮肤恶性肿瘤的临床特点.方法 该院收治的未见转移的面部皮肤恶性肿瘤患者411例,分为Mohs手术组256例,传统术中冷冻手术组130例,经验切除组25例,并对切取肿瘤创面采用邻近皮瓣、肌皮瓣及游离皮片或直接缝合方式修复.随访3～5年.结果 Mohs手术组248例手术切口Ⅰ期愈合,皮瓣或皮片全部成活,8例Ⅱ期愈合,2例复发(0.8％).传统术中冷冻手术组125例手术切口Ⅰ期愈合,5例Ⅱ期愈合,7例复发(5.4％).经验切除组25例均Ⅰ期愈合,4例复发(16％).各组术后病理复检发现,肿瘤残余和临床复发率差异有统计学意义(P ＜0.01).结论 Mohs手术可以在完整切除肿瘤的同时尽可能保留正常组织减少外观影响,是目前治疗头面部皮肤恶性肿瘤的首选方案.