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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 introduce the diagnosis and treatment of median nerve fatty fibroma. Methods From October 1993 to February 2004, 6 patients with median neurofibromatosis were treated with transected supportive band, median nerve release, simple tumor resection and median nerve excision. Surgery was found in the tumor usually along the median nerve was swollen growth growth such as spindle-shaped, the size of 1.0 ~ 2 .8 cm × 2 .1 ~ 13 .5cm. Complete epineurium, tumor and surrounding tissue clear boundaries. Nerve tracts have a large number of hyperplastic fat and fibrous tissue. Results Postoperative follow-up of 6 months to 5 years. Only 5 cases of simple tumor resection, only finger numb complications; but within 3 years after surgery, 4 cases of tumor recurrence. In 5 cases with median neurological resection (4 cases with recurrent tumor resection), the median central nerve area of 5 cases disappeared, and the thumb of 4 cases could not palpate. There was no recurrence in 1 case. Conclusion Diagnosis: The initial diagnosis of median nerve fat fibroids by surgery, histological examination of the tumor can be a clear diagnosis. Treatment: Simple tumor resection can relieve the symptoms, the line of the median neurological resection can eradicate the tumor, but at the same time the nerve graft and thumb paw function reconstruction.