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目的探讨扩大切除术结合Mohs显微描记手术(简称Mohs手术)治疗隆突性皮肤纤维肉瘤(dermatofi brosarcoma protuberans,DFSP)的方法及疗效。方法 2007年1月-2010年1月,收治17例DFSP患者。男9例,女8例;年龄16～55岁,平均33.2岁。头颈部2例,躯干12例,四肢2例,会阴部1例。初发6例,复发11例。病灶为单个或多个结节,部分结节融合,结节中央隆起可见皮肤萎缩、瘢痕或斑块,边缘不清。病灶直径为0.8～9.7 cm,平均4.3 cm。无远处转移或淋巴结转移。行扩大切除术结合Mohs手术彻底切除肿瘤后,采用直接拉拢缝合(3例)、游离植皮(9例)及皮瓣移位(5例)修复创面。结果扩大切除术后行Mohs切除1次13例,2次3例,3次1例。手术时间56～219 min,平均98.6 min。术后植皮及皮瓣均顺利成活,切口Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。患者均获随访,随访时间8～34个月,平均21.7个月。皮瓣色泽、质地与受区相似,外观良好。患者随访期间均无复发。结论扩大切除术结合Mohs手术治疗DFSP具有手术时间较短、肿瘤切除彻底及周围正常皮肤损伤小等优点。
Objective To investigate the method and effect of extended excision combined with Mohs microsurgery (Mohs operation) in the treatment of dermatofi brosarcoma protuberans (DFSP). Methods From January 2007 to January 2010, 17 patients with DFSP were treated. 9 males and 8 females; aged 16 to 55 years, an average of 33.2 years old. 2 cases of head and neck, trunk in 12 cases, limbs in 2 cases, 1 case of perineum. Initial onset of 6 cases, 11 cases of recurrence. The lesions were single or multiple nodules, some nodules were fused, and the atrophy of the nodules was visible in the central bulge, scar or plaque, and the margin was unclear. Lesion diameter of 0.8 ~ 9.7 cm, an average of 4.3 cm. No distant metastasis or lymph node metastasis. After radical resection combined with Mohs surgery, the wounds were completely repaired by direct suture (3 cases), free skin graft (9 cases) and flap displacement (5 cases). Results After the resection, 13 cases were treated with Mohs excision, 3 cases twice, and 1 case 3 times. The operative time ranged from 56 to 219 minutes with an average of 98.6 minutes. Postoperative skin grafts and flaps survived successfully, incisions healed first. Grafts for the area are alive, incision healed. All patients were followed up for 8 to 34 months with an average of 21.7 months. Flap color, texture and the area similar to the appearance of good. No recurrence during follow-up. Conclusion Expanded resection combined with Mohs surgery has the advantages of shorter operation time, complete tumor resection and less peripheral skin damage.