成人头面部巨大血管畸形手术治疗.doc

成人头面部巨大血管畸形手术治疗[摘要]目的：探讨成人头面部巨大血管畸形的手术切除与美容修复。方法：1998年9月以来，收治此类患者67例，占同期收治血管瘤与血管畸形患者的25.2%。术前通过CTA或MRI了解头面部血管畸形与颅内血管的关系；根据病变的部位、类型、范围选择不同的术式治疗，并于术中采用环状缝扎、电凝治疗、分区植皮等技术。结果：48例行大张中厚或全厚皮片移植修复创面者，皮片成活率≥95%，头部均遗留秃发畸形，面部术区外形基本满意；采用病灶切除+（电凝治疗）+直接缝合治疗的19例中，15例伤口发生不同程度创缘皮肤坏死，伤口裂开，其中3例行清创缝合术，12例经换药愈合；术后5个月～2年随访37例，27例效果满意，术区外形良好，局部无复发，10例局部有不同程度的复发，需二次手术治疗。结论：术前了解头面部血管畸形与颅内血管的关系至关重要；环状缝扎与电凝治疗有助于减少术中出血，简化切除难度，但电凝治疗对伤口愈合有一定影响；面部分区植皮有助于病灶切除后的美容修复。 [关键词]血管畸形；手术治疗；美容修复；头面部 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）06-0787-04 Surgical treatment of huge blood vessel deformities on craniofacial region in adults LIU Yi,ZHANG Bin,XIAO Bin,LIU Ping,JIANG Jiang,CHEN Li-ming,YANG Xue-li (Department of Burns and Plastic Surgery,Lanzhou General Hospital of Lanzhou Command,Lanzhou 730050,Gansu,China) Abstract:ObjectiveTo study the surgical excision and aesthetic repair of huge blood vessel deformities on craniofacial region in adults.MethodsSince September 1998, 67 patients with huge blood vessel deformity had been treated in our department, which occupied 25.2% of patients with angioma and blood vessel deformities at the same time. The relationship between blood vessel deformity and intracranial blood vessel was examined by CTA or MRI pre-operation. According to the position, type and range of lesion, different surgical procedure was chosen, and round suture and ligation, electrocoagulation and skin grafting in zonation were employed during operation.ResultsThe wounds were covered with split or full thickness skin graft in 48 cases, the survival rate of skin graft was equal or lager than 95%. Alopecia deformity left over in patients with lesion on head, and satisfactory appearances were showed on face. Of 19 cases with or without electrocoagulation and local suture after resection of lesion, shin necrosis on the wound edge in different degree occurred in 15 cases, among them, debridement and suturing was carried out in 3 cases, and the other wounds healed by dress exchange. 3