慢Mohs显微描记手术对隆突性皮肤纤维肉瘤的治疗效果及术后二期愈合特点分析

Analysis of therapeutic effect of slow-Mohs micrography on protuberant cutaneous fibrosarcoma and characteristics of secondary healing after operation

摘要:

目的 总结慢Mohs显微描记手术（sMMS）应用于隆突性皮肤纤维肉瘤治疗的效果，分析术后二期愈合特点。方法 回顾性分析2016年—2020年北京大学第一医院的106例隆突性皮肤纤维肉瘤患者的病历资料，统计分析其临床特征、sMMS治疗和二期愈合等相关参数。绘制散点图，采用直线回归方程分析临床资料的关系。结果 患者发病年龄集中于20～40岁，男∶女为1∶1.16，95例（89.6%）患者病程> 1年，76例（71.7%）患者发病部位为躯干部。sMMS治疗隆突性皮肤纤维肉瘤局部复发率为1.1%（1/106）；手术过程中57例（53.8%）患者可以1次手术切净，位于躯干部者更可能需要多次切除（57.9%）；根据sMMS 1次手术未切净的主要方位评判，深部未切净为主的患者［含单纯深部未净、边缘及深部未净（深部为主）］占1次手术肿瘤未净总患者数的85.7%。术后常遗留大面积组织缺损，55例（51.9%）创面长径≥ 10 cm；术后创面随着病程延长逐渐扩大，病程每增加1年，术后皮肤创面长径增加约0.22 cm。接受二期愈合的患者中，50.0%可于3个月内实现伤口愈合，其余患者于3～6个月愈合，两者的皮肤创面长径比较，差异无统计学意义（P >0.05）；二期愈合时间与皮肤创面长径无相关性（R² =0.005，P =0.660），躯干部位二期愈合时间与皮肤创面长径无相关性（R² =0.0134，P =0.502），表皮爬行速度与年龄无相关性（R² =0.0008，P =0.859）。结论 本研究描述了隆突性皮肤纤维肉瘤患者的临床特征，展示了sMMS治疗的特点及优越性，且初步明确了sMMS之后行二期愈合的可行性。

Abstract:

Objective To explore the features of slow-Mohs micrographic surgery (sMMS) in the treatment of dermatofibrosarcoma protuberans (DFSP) and depict the characteristics of secondary healing after complete excision.Methods DFSP cases treated in Peking University First Hospital from 2016 to 2020 were reviewed. Clinical features, parameters generated during sMMS, and following secondary healing process were analyzed using statistical methods. Scatter plot was drawn and linear regression equation was used to analyze the relationship between clinical data.Results The onset age of the patients was concentrated from 20 to 40 years old, and the ratio of male to female was 1:1.16. The course of disease was > 1 year in 95 patients (89.6%), and the main site of onset was trunk in 76 patients (71.7%). The local recurrence rate of dermatofibrosarcoma carina treated with SMMs was 1.1% (1 / 106). During the operation, 57 patients (53.8%) could be resected at one time, and those located in the trunk were more likely to need multiple resection (57.9%). According to the evaluation of the main directions of uncleared tumors in one operation of sMMS, patients with deep unresected tumors [including simple deep unresected tumors, edges and deep unresected tumors (mainly deep tumors)] accounted for 85.7% of the total number of patients with unresected tumors in one operation. Large area tissue defects were often left after operation. The length and diameter of wound in 55 cases (51.9%) were ≥ 10 cm. The postoperative wound gradually expanded with the extension of the disease course, and the length and diameter of the skin wound increased by about 0.22 cm every year. Among the patients who received secondary healing, 50.0% could achieve wound healing within 3 months, and the rest healed within 3 to 6 months. There was no significant difference in the length and diameter of skin wounds between the two groups (P > 0.05). There was no correlation between the time of secondary healing and the length and diameter of skin wound (R² = 0.005, P = 0.660), there was no correlation between the time of secondary healing of trunk and the length and diameter of skin wound (R² = 0.0134, P = 0.502), and there was no correlation between epidermal crawling speed and age (R² = 0.0008, P = 0.859).Conclusion This study explored the clinical characteristics of DFSP in a Chinese population. We presented with detailed description of the application of sMMS in DFSP and confirmed its advantageous therapeutic effects. Besides, this study provided preliminary evidences for the clinical use of secondary healing.