足底部恶性黑色素瘤切除术后两种修复方法临床疗效观察

摘要

Objective: To compare the efficacy of two kinds of reparation methods after resection of cutaneous ma-lignant melanoma on foot. Methods:Thirty-one patients with malignant melanoma on foot were treated from July 2006 to February 2014. The patients included 14 males and 17 females. According to clinical classification,there were 2 cases of Grade I,9 cases of GradeⅡ,and 20 cases of GradeⅢ. Local extensive resection and groin dissection were performed in all cases. The surgical margin should be greater than 2 cm away from the tumors. The foot defect caused by dissection of mela-noma were repaired with skin graft or plantar flap, skin graft from inguinal wound (11 patients ,group A) or from thigh by dermatome (20patients ,group B). The operation time, intraoperative bleeding volume, the number of the resected lymph nodes, length of stay hospitalization, expenses, complications of inguinal wound , tumor recurrence were observed. Re-sults:skin graft or plantar flap all survived and there was no tumor recurrence in these two groups. The length of stay hospi-talization, expenses and postoperative complications in inguinal wound in group A were significantly less than those in group B (P<0. 05). There was no significant difference in the operation time, intraoperative bleeding volume and the number of resected lymph nodes between these two groups(P>0. 05). Conclusion:Reparation with skin graft from inguinal wound is an ideal treatment for foot defect caused by resection of melanoma and can achieve satisfactory clinical outcomes because it has shorter length of stay hospitalization, less expenses and lower postoperative complications than the reparation with skin graft from thigh by dermatome.%目的：比较足底部皮肤恶性黑色素瘤切除术后两种修复方法的疗效。方法：回顾性分析2006年7月~2014年2月我院收治31例足底部皮肤恶性黑色素瘤患者临床病理资料,其中男14例,女17例。临床分期：I期2例,Ⅱ期9例,Ⅲ期20例。手术均行距肿瘤边缘2cm的广泛切除+腹股沟淋巴结清扫术；足底肿瘤切除术后缺损以两种方式修复,A组(11例)：直接从同侧腹股沟切口取全厚皮片修复或皮瓣修复+取同侧腹股沟全厚皮片修复供皮瓣区。 B组(20例)：直接取同侧大腿中厚皮片植皮修复或皮瓣修复+取同侧大腿中厚皮片修复供皮瓣区；比较两组患者的手术时间、术中出血量、术中淋巴结清扫数目、住院时间、住院费用、腹股沟伤口并发症及足底局部复发情况等方面的差异。结果：术后足底缺损区植皮或皮瓣完全成活,肿瘤均无局部复发。两种方法在住院时间、住院费用及腹股沟伤口术后并发症方面差异有统计学意义(p<0．05),两组患者手术时间、术中出血量、术中淋巴结清扫数目方面差异无统计学意义(p>0．05)。结论：与从同侧大腿取中厚皮片修复相比,从腹股沟切口直接取全厚皮片修复减少手术伤口,并发症少,住院时间短,住院费用低,是一种较理想的修复方法。