超选择动脉栓塞联合外科序贯治疗I型神经纤维瘤伴巨大神经纤维瘤临床疗效观察

来源:用户上传      作者:徐潇　周桂文　陈康　杨亦　付强　陈敏亮

　　[摘要]目的：探究DSA联合外科序贯治疗是否可以作为I型神经纤维瘤伴巨大神经纤维瘤的重要治疗策略之一。方法：纳入2017年7月-2021年8月收治的11例神经纤维瘤患者作为研究对象。肿瘤大多位于躯干及四肢，瘤体重量2.5～25 kg。全部患者术前备自体血，瘤体切除术前介入超选择栓塞瘤体滋养动脉及其分支，切除瘤体后将栓塞后的部分瘤w组织制备皮瓣及全厚皮片回植于继发创面。观察患者术后恢复情况及并发症发生情况。结果：11例患者中，9例在瘤体切除术后利用部分瘤体皮肤制备全厚皮片回植于组织缺损区域，2例制备皮瓣回植。其中1例患者回植后全厚皮片少部分坏死，经换药等保守治疗愈合可。随访至今，11例患者术后均无复发，术后肢体外形改善，恢复正常行走等组织功能。结论：超选择栓塞瘤体滋养动脉及其分支联合序贯疗法，在治疗NF-I合并巨大神经纤维瘤中术中失血量小，术后并发症少，患者恢复效果好，可作为该疾病的一种治疗策略。
　　[关键词]I型神经纤维瘤病;巨大神经纤维瘤;介入治疗;超选择动脉栓塞;外科序贯治疗;皮瓣回植
　　[中图分类号]R771.3 [文献标志码]A [文章编号]1008-6455（2022）01-0009-04
　　Clinical Observation of Super-Selective Arterial Embolization Combined with Sequential Surgery in the Treatment of TypeⅠ Neurofibromatosis with Giant Neurofibroma
　　XU Xiao，ZHOU Guiwen，CHEN Kang，YANG Yi，FU Qiang，CHEN Minliang
　　（Senior Department of Burns and Plastic Surgery，the Fourth Medical Center of PLA General，Beijing 100048，China）
　　Abstract： Objective To explore whether DSA combined with surgical sequential therapy can be one of the important treatment strategies for NF-I with giant neurofibromas. Methods From July 2017 to August 2021， a total of 11 patients with neurofibromatosis were enrolled as research subjects. Most of the tumors are located in the trunk and limbs， and the weight of the tumor is 2.5 to 25 kg. All patients were prepared with autologous blood before surgery. Before tumor resection， the nutrient artery and its branches were superselective intervention embolized.After tumor resection， the partial tumor tissue after embolization was prepared with skin flap and full thickness skin graft was implanted on the secondary wound .The postoperative recovery and complications of the patients were observed. Results Of the 11 patients， 9 patients were replanted with full thickness skin grafts from part of the tumor skin after tumor resection， and 2 patients were replanted with skin flaps. One patient with full thickness skin grafts caused a small amount of necrosis after replantation， and healed after conservative treatment such as dressing changes. Up to now， 11 patients had no recurrence after operation， and the limb appearance improved after operation， and the tissue functions such as walking were restored. Conclusion Superselective embolization of the tumor feeding artery and its branches combined with sequential therapy in the treatment of NF-I complicated with giant neurofibromas， has less intraoperative blood loss， less postoperative complications， and good recovery effect， which can be used as a conventional treatment strategy for the disease.
转载注明来源:https://www.xzbu.com/6/view-15422949.htm