手指复发血管球瘤的手术治疗(1)
【摘要】 目的 探讨并总结手指复发血管球瘤的诊断与治疗方法。方法 手术治疗的复发手指血管球瘤13例，其中男2例，女11例，年龄17~38岁，其中食指4例，中指5例，环指和小指各2例。第一次手术后到再次手术的时间最短1月，最长5年，平均1.3年。13例患者中在术后有6例曾被误诊为甲沟炎 、术后感染或伤口内异物。部分病例术前行彩色多普勒检查。13例患者均采用手术治疗。结果 术后所有患者经病理学检查均诊断为血管球瘤。手术后疼痛三联征消失，伤口无一例感染患者，1例患者甲床小部分坏死，经换药后愈合，指甲生长欠平滑4例，患者术后对于手指外观满意率85.6%。结论 正确认识并诊断复发血管球瘤，并选择合理的手术入路，彻底切除肿瘤以减少复发，是取得良好治疗结果的关键。
【关键词】血管球瘤；手指；手术治疗
Surgical treatment of the recrudescent glomus tumors of the fingers
, 百拇医药
QI Yong，LI Gui-tao，WU Guang-qin，et al.Department Orthopaedics， The Second Hospital of Guangdong Province， Guangzhou 510317，China
【Abstract】 Objective To summarize the diagnosis and surgical treatment of the recrudescent glomus tumors of the fingers.Methods 13 cases with recrudescent glomus tumors of the fingers were analysed retrospectively.Among these cases， three patients were male， and 11 were female.The ages arranged from 17 to 38 years old.4 cases occurred in index finger， 5 in middle fingers， 2 in ring fongers and 2 in little fingers.The mean interval period from the first operation to the second surgery is about 13 months， the shortest was 1 month， and the longest was 5 years.Among these 13 cases， 6 patients have been misdiagnosed as panaritium， postoperative infection or corpus alienum.Some patients accepted color Doppler in order to identify the diagnose and whether there were tumors in palm side of the fingers， especially when patients feel pain at the palm of the fingers.All the cases underwent surgical treatment.Results During the operation we found that 6 cases had two or more tumor bodies.All the case were verified by pathology.The triad of pain were disappeared in all patients without infection.But a small area of nail necrosed in one case， and healed after change of dressing.4 nails appeared unsmooth after surgery.About 85.6%of the cases were satisfied about the results.Conclusion The local recrudescent glomus tumors of the fingers shoud be diagnosed definitely and better understood.If the operation were practiced through reasonable approach， and tumors were resectted thoroughly， a excellent clinical result can be got.
, 百拇医药
【Key words】Glomus tumor;Finger;Surgical treatment
血管球瘤(glomus tumor ，GT)是一种较为少见的真性肿瘤，源自细小动静脉吻合处的血管球，多见于手指甲床下或甲床旁，在创伤等诱因下变异而来[1]。由于结缔组织包膜中有丰富的神经末稍，因此临床上手部血管球瘤具有典型的间歇性剧痛、难以忍受的触痛以及疼痛有冷敏感性的“三联征”。血管球瘤明确诊断后，手术切除是唯一有效的治疗方法。如何做到将肿瘤既完全切除，减少复发，又能使指甲不遗留任何美观方面的并发症，是手术成功与否的关键。鉴于血管球瘤的特点，对于复发以及同一部位再发的血管球瘤，临床上是难于鉴别的[2]，但治疗原则相同，所以在此我们将其统一作复发血管球瘤处理。对于这一部分患者的再手术治疗，临床报道较少，且有一定的难度。作者分析总结了手指血管球瘤手术后同一部位再次出现血管瘤而再手术的13例病例，就其临床特点以及再手术的有关问题作以下总结。
, http://www.100md.com
1 资料与方法
1.1 一般资料 本组共13例，其中男2例，女11例，年龄17~38岁，平均26.7岁。其中食指4例，中指5例，环指和小指各2例。第一次手术后到再次手术的时间最短1个月，最长5年，平均1.3年。13例患者中在术后有6例曾被误诊为甲沟炎、术后感染或伤口内异物。入院后对于指腹侧有压痛的病例常规行彩色多普勒检查，术前发现3例同时存在指掌侧血管球瘤。
1.2 手术方法 手术在臂丛神经阻滞下进行，指根部橡皮条止血。手术入路根据血管球瘤的位置选择：如血管球瘤位于指甲下正中，瘤体小，则选择指甲开窗手术，纵形切开甲床，显露瘤体；如果瘤体较大，指甲呈悬浮状或肿瘤位置偏于一侧，则选择一侧甲襞旁切口，通过甲床下分离，游离瘤体。在分离瘤体与甲床时，使用精细的神经剥离子在显微镜下剥离，并注意寻找血管蒂。如发现有明显的血管蒂，则沿血管蒂继续追踪至发生病变的微细血管，彻底切除瘤蒂。术毕使用7-0无创伤线修复甲床。本组病例中经手术中探查发现有6例患者同时有指背及指腹侧血管瘤，均予以切除。
2 结果, http://www.100md.com(齐 勇 李贵涛 武光勤 徐汪洋)
【关键词】血管球瘤；手指；手术治疗
Surgical treatment of the recrudescent glomus tumors of the fingers
, 百拇医药
QI Yong，LI Gui-tao，WU Guang-qin，et al.Department Orthopaedics， The Second Hospital of Guangdong Province， Guangzhou 510317，China
【Abstract】 Objective To summarize the diagnosis and surgical treatment of the recrudescent glomus tumors of the fingers.Methods 13 cases with recrudescent glomus tumors of the fingers were analysed retrospectively.Among these cases， three patients were male， and 11 were female.The ages arranged from 17 to 38 years old.4 cases occurred in index finger， 5 in middle fingers， 2 in ring fongers and 2 in little fingers.The mean interval period from the first operation to the second surgery is about 13 months， the shortest was 1 month， and the longest was 5 years.Among these 13 cases， 6 patients have been misdiagnosed as panaritium， postoperative infection or corpus alienum.Some patients accepted color Doppler in order to identify the diagnose and whether there were tumors in palm side of the fingers， especially when patients feel pain at the palm of the fingers.All the cases underwent surgical treatment.Results During the operation we found that 6 cases had two or more tumor bodies.All the case were verified by pathology.The triad of pain were disappeared in all patients without infection.But a small area of nail necrosed in one case， and healed after change of dressing.4 nails appeared unsmooth after surgery.About 85.6%of the cases were satisfied about the results.Conclusion The local recrudescent glomus tumors of the fingers shoud be diagnosed definitely and better understood.If the operation were practiced through reasonable approach， and tumors were resectted thoroughly， a excellent clinical result can be got.
, 百拇医药
【Key words】Glomus tumor;Finger;Surgical treatment
血管球瘤(glomus tumor ，GT)是一种较为少见的真性肿瘤，源自细小动静脉吻合处的血管球，多见于手指甲床下或甲床旁，在创伤等诱因下变异而来[1]。由于结缔组织包膜中有丰富的神经末稍，因此临床上手部血管球瘤具有典型的间歇性剧痛、难以忍受的触痛以及疼痛有冷敏感性的“三联征”。血管球瘤明确诊断后，手术切除是唯一有效的治疗方法。如何做到将肿瘤既完全切除，减少复发，又能使指甲不遗留任何美观方面的并发症，是手术成功与否的关键。鉴于血管球瘤的特点，对于复发以及同一部位再发的血管球瘤，临床上是难于鉴别的[2]，但治疗原则相同，所以在此我们将其统一作复发血管球瘤处理。对于这一部分患者的再手术治疗，临床报道较少，且有一定的难度。作者分析总结了手指血管球瘤手术后同一部位再次出现血管瘤而再手术的13例病例，就其临床特点以及再手术的有关问题作以下总结。
, http://www.100md.com
1 资料与方法
1.1 一般资料 本组共13例，其中男2例，女11例，年龄17~38岁，平均26.7岁。其中食指4例，中指5例，环指和小指各2例。第一次手术后到再次手术的时间最短1个月，最长5年，平均1.3年。13例患者中在术后有6例曾被误诊为甲沟炎、术后感染或伤口内异物。入院后对于指腹侧有压痛的病例常规行彩色多普勒检查，术前发现3例同时存在指掌侧血管球瘤。
1.2 手术方法 手术在臂丛神经阻滞下进行，指根部橡皮条止血。手术入路根据血管球瘤的位置选择：如血管球瘤位于指甲下正中，瘤体小，则选择指甲开窗手术，纵形切开甲床，显露瘤体；如果瘤体较大，指甲呈悬浮状或肿瘤位置偏于一侧，则选择一侧甲襞旁切口，通过甲床下分离，游离瘤体。在分离瘤体与甲床时，使用精细的神经剥离子在显微镜下剥离，并注意寻找血管蒂。如发现有明显的血管蒂，则沿血管蒂继续追踪至发生病变的微细血管，彻底切除瘤蒂。术毕使用7-0无创伤线修复甲床。本组病例中经手术中探查发现有6例患者同时有指背及指腹侧血管瘤，均予以切除。
2 结果, http://www.100md.com(齐 勇 李贵涛 武光勤 徐汪洋)