CAJ | 학술논문

目的了解瘢痕癌患者的临床特征及诊疗方法. 方法回顾性分析2007年1月—2013年1月笔者单位收治的21例瘢痕癌患者的临床资料,统计其年龄、性别、致伤原因、原发病发展至瘢痕癌的时间、溃疡持续时间、病变部位、溃疡区面积、溃疡区症状、术前细菌学培养结果、组织病理学类型、癌细胞分化程度、侵袭深度、治疗方法以及预后情况. 结果 (1)21例瘢痕癌患者年龄为19 ～74(47±13)岁,男女比例约为0.9∶1.0.(2)原发病以火焰烧伤、热液烫伤为主,分别为12例占57.1％、7例占33.3％;原发病发展至瘢痕癌的时间为10 ～56(40±14)年.(3)12例患者的瘢痕溃疡持续时间超过1年,占57.1％.(4)病变部位常见于四肢、头面部,分别为13例占61.9％、6例占28.6％.(5)溃疡区面积为0.25 ～ 74.25(39±25)cm2.多数患者溃疡区出现恶臭分泌物、出血、疼痛加剧、溃疡面积逐渐扩大现象.(6)术前细菌学培养显示,16例患者创面分泌物培养呈阳性,占76.2％;血培养结果均为阴性.(7)组织病理学观察显示,20例患者为鳞状细胞癌、1例患者为基底细胞癌,分化程度以高、中分化为主,近40％患者的癌细胞侵袭至皮下组织或更深.(8)患者均采用手术治疗,其中11例患者切除病灶后行自体皮移植术、5例患者切除病灶后行皮瓣修复术、5例患者行截肢术.12例患者术后接受康复治疗,占57.1％.本组2例癌细胞肺部转移患者接受化学治疗.(9)术后大多数皮瓣或皮片存活良好,少数未成活者经再次植皮修复.随访6个月～5年,4例患者复发瘢痕癌,其中2例死亡;其余患者存活良好. 结论笔者单位收治瘢痕癌多为鳞状细胞癌.对瘢痕溃疡病程长、反复发作的患者,应考虑病理学确诊.目前手术切除仍是治疗瘢痕癌的首选方法;瘢痕癌切除术后应定期随访,监测癌变是否复发转移.
목적 료해반흔암환자적림상특정급진료방법. 방법 회고성분석2007년1월—2013년1월필자단위수치적21례반흔암환자적림상자료,통계기년령、성별、치상원인、원발병발전지반흔암적시간、궤양지속시간、병변부위、궤양구면적、궤양구증상、술전세균학배양결과、조직병이학류형、암세포분화정도、침습심도、치료방법이급예후정황. 결과 (1)21례반흔암환자년령위19 ～74(47±13)세,남녀비례약위0.9∶1.0.(2)원발병이화염소상、열액탕상위주,분별위12례점57.1％、7례점33.3％;원발병발전지반흔암적시간위10 ～56(40±14)년.(3)12례환자적반흔궤양지속시간초과1년,점57.1％.(4)병변부위상견우사지、두면부,분별위13례점61.9％、6례점28.6％.(5)궤양구면적위0.25 ～ 74.25(39±25)cm2.다수환자궤양구출현악취분비물、출혈、동통가극、궤양면적축점확대현상.(6)술전세균학배양현시,16례환자창면분비물배양정양성,점76.2％;혈배양결과균위음성.(7)조직병이학관찰현시,20례환자위린상세포암、1례환자위기저세포암,분화정도이고、중분화위주,근40％환자적암세포침습지피하조직혹경심.(8)환자균채용수술치료,기중11례환자절제병조후행자체피이식술、5례환자절제병조후행피판수복술、5례환자행절지술.12례환자술후접수강복치료,점57.1％.본조2례암세포폐부전이환자접수화학치료.(9)술후대다수피판혹피편존활량호,소수미성활자경재차식피수복.수방6개월～5년,4례환자복발반흔암,기중2례사망;기여환자존활량호. 결론 필자단위수치반흔암다위린상세포암.대반흔궤양병정장、반복발작적환자,응고필병이학학진.목전수술절제잉시치료반흔암적수선방법;반흔암절제술후응정기수방,감측암변시부복발전이.
Objective To investigate the clinical manifestation,diagnosis,and treatment of patients with Marjolin's ulcers.Methods The clinical materials of 21 patients with Marjolin's ulcers hospitalized from January 2007 to January 2013 were retrospectively analyzed,including age,gender,injury causes,duration time of primary disease in developing Marjolin's ulcer,duration of ulcer,lesion site,ulcer area,symptoms and signs of ulcer region,bacterial culture results before operation,histopathological type,grade of carcinoma cell differentiation,depth of invasion,treatment,and outcome.Results (1) The age of 21 patients at the time of diagnosis of Marjolin's ulcers was 19-74 (47 ± 13) years,and the ratio of male to female was nearly 0.9∶ 1.0.(2) The main primary lesions were flame burns and high temperature liquid scald,respectively occurred in 12 cases (57.1％) and 7 cases (33.3％).The time for development of Marjolin's ulcers from primary injury was 10-56 (40 ± 14) years.(3) Ulceration on top of scar lasted for longer than one year in 12 patients (57.1％).(4) Lesion site was mainly located in the limbs in 13 patients (61.9％),and on head and face in 6 patients (28.6％),respectively.(5) Ulcer area ranged 0.25-74.25 (39 ± 25) cm2.Foul excretion,bleeding,intensified pain,and gradual enlargement of ulceration were observed in the lesion of most patients.(6) Bacterial cuhure of wound excretion before operation showed positive results in 16 patients (76.2％).Results of bacterial culture of blood were negative in all patients.(7) Pathological examination revealed squamous cell carcinoma in 20 cases and basal cell carcinoma in 1 case,and mostly of high or medium differentiation.Cancer cells in nearly 40％ patients had invaded the subcutaneous tissue or deeper area.(8) All patients were treated by surgery,among them autologous skin grafting was done after excision of lesion in 1 1 patients,and in 5 patients the defects were closed with skin flaps after excision of lesion,and in 5 patients limbs harboring the lesion were amputated.Twelve patients (57.1％) received postoperative rehabilitation treatment.Two patients with pulmonary metastasis received chemotherapy.(9) Most of the flaps and skin grafts survived well after surgery,and a few cases with failure of skin grafting or transplantation of flaps underwent skin grafts again.Patients were followed up for 6 months to 5 years,in 4 patients recurrence occurred after surgery,and 2 of them died.The other patients survived without recurrence.Conclusions Squamous cell carcinoma was the most common pathological type of Marjolin's ulcer admitted to our unit.A recurrent ulcer with long course should be considered as Marjolin's ulcer,and it should be scrutinized pathologically.Currently,surgery remains the optimal treatment for Marjolin's ulcer.Regular follow-up should be carried out after resection of the lesion to detect carcinoma recurrence and metastasis.