摘要目的:探讨水刀削切联合皮片移植治疗巨型先天性黑色素痣的临床效果。方法:以2015年1月至2019年5月，解放军总医院整形修复科收治的符合入选标准的巨痣患者为研究对象，所有患者均采用水刀逐层削切巨痣，尽量保留皮下筋膜层及部分真皮层，创面以皮片移植术治疗。术后1～2年来院复诊，采用患者和观察者瘢痕评估量表(POSAS)对植皮区术后瘢痕进行评分(每项分值为1～10分，分值越大表示状况越差)，采用数字评分法(1～10分)对植皮区满意度进行评价(10分为非常满意，7～9分为满意，6分以下为不满意)，观察色素痣复发及种植转移情况。采用描述性方法进行统计分析。结果:共纳入7例患儿，男2例，女5例，年龄4～14岁。躯干3例，四肢4例。巨痣占体表面积的(7.4±3.1)%。7例巨痣患儿术后皮片均成活良好。术后1年随访，植皮区瘢痕POSAS评分显示，患者或家属对植皮区瘢痕疼痛、瘙痒、硬度、厚度评分为1～3分的分别有6、4、4、5例，色素沉着及不规则度中评分为4～10分的分别有5、5例。7例患者中植皮区均无功能受限；医生对植皮区瘢痕的血管分布、色素沉着、厚度、柔韧性评分均较低，评为1～3分的分别有6、3、4、4例，对平整度中评分为1～3分和4～6分的分别有2、4例。医患双方满意度：评分为7～10分的分别有4、5例。7例术后1年复查，其中6例植皮区未见色素痣复发，1例可见2处点状色素痣复发，直径均小于1 mm；7例均未见色素痣取皮区种植转移。结论:水刀削切联合皮片移植治疗巨痣，手术操作简单，一次性切除，供区只需切取刃厚皮片，术后瘢痕不明显、皮肤弹性较好、患者满意度高，适用于躯干及四肢非关节部位的色素痣切除，尤其是质地良好、颜色较浅的色素痣。

abstractsObjective:To investigate the clinical effect of water-jet excision combined with skin graft in the treatment of giant congenital melanotic nevus.Methods:The patients with giant nevus who were admitted to the Department of Plastic Surgery, Chinese PLA General Hospital from January 2015 to May 2019 were retrospectively analyzed. All patients were treated by layer-by-layer cutting of giant nevus with water-jet, preserving the subcutaneous fascial layer and part of the dermis as much as possible, then following by skin graft transplantation. The patients visited the hospital 1-2 years after operation. The postoperative scar of skin graft area was scored by Patient and Observer Scar Assessment Scale (POSAS), and the satisfaction of skin graft area was evaluated by digital scoring method (1-10 points). The recurrence of nevus pigmentosus and implantation metastasis were observed. Descriptive method were used for statistical analysis.Results:A total of 7 children were included, 2 males and 5 females, aged 4 to 14 years. There were 3 cases on the trunk and 4 cases on the extremities. Giant nevi accounted for (7.4 ± 3.1)% of the body surface area. Then skin graft survived well after surgery in all 7 children. During the 1-year follow-up after operation, the POSAS score of skin graft scar showed that the sum of 1-3 points in the scores of scar pain, itching, hardness and thickness by the patients or their families was 6, 4, 4 and 5 cases, respectively, and the sum of 4-10 points in the pigmentation and irregularity was 5 and 5 cases, respectively. None of the 7 patients had functional limitation in the skin graft area; the physicians’, scores for vascularity, pigmentation, thickness, and flexibility of the scars in the skin graft area were low, with a sum of 6, 3, 4, and 4 for the number of cases with 1-3 points and 2 and 4 for the number of cases with 1-3 points and 4-6 points in the flatness score, respectively. The satisfaction of both doctors and patients (sum of 7-10 points) was 4 and 5 cases, respectively. 7 cases were reexamined 1 year after operation, with recurrence of 2 punctate nevus pigmentosus(less than 1 mm in diameter) in only one case. No implantation metastasis in the skin graft area of nevus pigmentosus happened.Conclusions:Water-jet excision combined with skin graft in the treatment of giant nevus is simple and only one procedure required. The donor site only needs to cut a split-thickness skin graft. The postoperative scar is not obvious and the skin elasticity is better. Patients were relatively satisfied with the postoperative effect. It is suitable for the resection of nevus pigmentosus in the trunk especially the nevus pigmentosus with good texture and lighter color but not for the lesion at articular area of limbs.