摘要
目的 介绍正中神经脂肪纤维瘤的诊治经验。方法 1993年 10月至 2 0 0 4年 2月 ,采用屈肌支持带切断、正中神经松解、单纯肿瘤切除和正中神经病段切除术治疗正中神经脂肪纤维瘤 6例。术中发现肿瘤通常沿正中神经的走行呈膨胀性生长如纺锤形 ,大小为 1.0～ 2 .8cm× 2 .1～ 13 .5cm。神经外膜完整 ,肿瘤与周围组织分界清楚。神经束间有大量增生的脂肪和纤维组织。结果 术后随访 6个月～5年。行单纯肿瘤切除的 5例 ,仅有手指麻木的并发症 ;但在术后 3年内有 4例肿瘤复发。行正中神经病段切除术的 5例 (4例为单纯肿瘤切除的复发病例 ) ,术后 5例的正中神经支配区感觉均消失 ,4例的拇指不能对掌 ;无 1例肿瘤复发。结论 诊断 :通过手术可初步诊断为正中神经脂肪纤维瘤 ,肿瘤的组织学检查才能明确诊断。治疗 :单纯肿瘤切除术可缓解症状 ,行正中神经病段切除术可根除肿瘤 ,但需同时行神经移植与拇指对掌功能重建术。
Objective To report the clinical experience of diagnosis and treatment of lipofibroma of the median nerve.Methods Between October 1993 and February 2004,six cases were treated by carpal tunnel release,simple excision of the tumour and radical surgical excision of the median nerve. Surgical exploration revealed typical fusiform tumors with 1.0 ～2.8cm × 2.1～13.5cm in size. There was integrate epineurium and clear demarkation between the tumor and the peripheral tissue. Histologically, the scattered nerve bundles were dissociated by considerable fat and fibrous tissue. Results Follow-up was from 6 months to 5 years. Numbness was only the complication in five cases treated by simple excision of tumour. But soft tissue mass recurred within 3 years in four patients. Five cases (4 recurrent patients) were treated by radical surgical excision of the median nerve. The severe complications involved persistent sensory function loss of the median nerve in 5 patients and dysfunction of thumb opposition in 4 patients. There was no recurrence. Conclusion 1.Primary diagnosis of lipofibroma of the median nerve is made by surgical exploration and final diagnosis by histological examination.2. Single excision of tumor can result in remission of the symptoms. Radical surgical excision of the median nerve can prevent recurrence. But it requires nerve grafting and reconstruction of thumb opposition.
出处
《中华手外科杂志》
CSCD
2004年第4期203-205,共3页
Chinese Journal of Hand Surgery
