皮瓣在足踝部恶性黑色素瘤保肢手术中的应用研究

发布时间：2018-03-25 17:20

本文选题：皮瓣　切入点：足踝部　出处：《吉林大学》2012年硕士论文

【摘要】：目的：通过总结我科自1999年至2010年间所收治的足踝部恶性黑色素瘤患者的临床资料和病例随访，比较不同类型皮瓣手术的治疗效果和远期存活率，讨论足踝部恶性黑色素瘤的较为理想的治疗方案，积累临床经验，为今后相关疾病的诊治提供理论和技术支持。方法：1999年至2010年，我科共收治足踝部恶性黑色素瘤患者21例。通过对此21例患者临床资料的分析总结，以及术后远期随访患者存活情况、肿瘤有无复发及转移，以及皮瓣生长及感觉恢复情况，探讨以病灶扩大切除、皮瓣修复软组织缺损的方法治疗足踝部恶性黑色素瘤的可行性。结果：通过回顾临床资料及病例随访总结出该治疗方案的远期疗效（1）所有患者术后病理结果回报均为恶性黑色素瘤，且切缘未见癌细胞；（2）7例死亡（其中1例因心脑血管疾病死亡，3例就诊时已发现腹股沟淋巴结转移，后发生远处转移，另3例分别于术后6个月、13个月及22个月发生复发及转移）；（3）各种皮瓣均成活良好，耐磨，大部分患者皮瓣具有保护性感觉。（4）患者主诉皮瓣不影响穿鞋、行走等日常生活活动。结论：（1）早期足踝部恶性黑色素瘤通过病灶扩大切除，肿瘤复发及转移概率未见增高，保肢具有临床意义。（2）应用皮瓣手术可以很好的解决肿物切除后创面软组织缺损的问题，皮瓣在外形及功能上能达到较好的修复效果。（3）对于足踝部早期恶性黑色素瘤，肿物扩大切除，皮瓣修复软组织缺损的手术方法保肢成功率较高，辅以化疗及生物治疗，预后效果更好。（4）保肢手术不仅最大程度的保留了肢体，，且有助于减轻患者的经济负担及心理负担，利于病情恢复。
[Abstract]:Objective: to summarize the clinical data and follow-up of patients with ankle malignant melanoma treated in our department from 1999 to 2010, and to compare the therapeutic effect and long-term survival rate of different types of flap operation. To discuss the ideal treatment for malignant melanoma of foot and ankle, accumulate clinical experience and provide theoretical and technical support for the diagnosis and treatment of related diseases in the future. Methods: from 1999 to 2010, 21 patients with malignant melanoma of ankle and foot were treated in our department. As well as the growth and sensory recovery of the skin flap, the feasibility of the treatment of malignant melanoma of foot and ankle with expanded resection of lesion and repair of soft tissue defect was discussed. Results: by reviewing the clinical data and following up the cases, we concluded that the long-term curative effect of this treatment regimen was 1) all the patients had malignant melanoma after operation. There were 7 cases of cancer cell death (1 case died of cardiovascular and cerebrovascular disease 3 cases had found inguinal lymph node metastasis, and then distant metastasis occurred). The other 3 cases had recurrence and metastasis at 6 months, 13 months and 22 months after operation respectively. All kinds of flaps survived well and were wear-resistant. Most of them had protective sensation. 4) the patients complained that the skin flap did not affect the activities of daily life such as wearing shoes and walking. Conclusion (1) in the early stage of malignant melanoma of ankle and foot, the probability of recurrence and metastasis was not increased, and the recurrence and metastasis rate of the tumor was not increased. (2) the flap operation can solve the problem of soft tissue defect of the wound after resection of tumor. The shape and function of the flap can reach a better repair effect.) for the early malignant melanoma of the ankle and foot, the surgical method of extensive excision of the tumor and the repair of the soft tissue defect by the flap has a higher success rate of limb salvage, and is supplemented with chemotherapy and biological therapy. The prognosis is better. (4) limb salvage surgery not only saves the limbs to the greatest extent, but also helps to reduce the economic and psychological burden of the patients, and is conducive to the recovery of the disease.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.5

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