外鼻肿物129例临床特征、切除修复策略及预后分析

Clinical characteristics, excision and reconstruction strategies, and prognostic analysis of 129 external nasal lexions

摘要

目的 分析外鼻肿物的临床及病理学特征，探讨不同病理类型、发病部位及修复方式与预后的关系，为规范化诊治及综合修复提供参考。方法 回顾性收集江苏省人民医院耳鼻咽喉头颈外科自2019年1月1日至2025年12月1日收治并经病理证实的外鼻肿物患者资料，记录性别、年龄、病变性质(非肿瘤性病变、良性肿瘤、恶性肿瘤)、病理类型、发病部位、手术方式及术后修复方法，并结合随访资料进行预后分析。采用χ²检验、Kruskal-Wallis检验及Mann-Whitney U检验等统计学方法进行组间比较。结果 本组共纳入外鼻肿物患者129例，其中男69例、女60例，男∶女为1.15∶1.00，年龄6~99(60.02±16.73)岁。非肿瘤性病变14例、良性肿瘤32例、恶性肿瘤83例。三组间性别构成差异有统计学意义(χ²=8.22，P=0.016)；非肿瘤、良性与恶性三组年龄分布差异亦具有统计学意义(χ²=23.12，P<0.001)，且恶性肿瘤患者年龄高于良性肿瘤(P<0.001)。良性肿瘤以皮内痣最常见(43.8%)，恶性肿瘤则以表皮来源的基底细胞癌和鳞状细胞癌为主(分别占63.9%和26.5%)。整体上外鼻肿物多发生于鼻翼和鼻背等暴露部位，发病部位与肿瘤良恶性之间相关性差异无统计学意义(P>0.05)。所有病例均行肿物完整切除，根据缺损范围和立体结构选择对位缝合、鼻唇沟瓣、额瓣、临近皮瓣等多种修复方式。结论 本组外鼻肿物以老年患者及恶性上皮性肿瘤为主要构成，发病部位多位于鼻翼与鼻背。对疑似恶性或边界不清病变应充分切除并联合立体重建与功能、美观兼顾的皮瓣修复；特殊类型如淋巴瘤及软组织肿瘤需提高警惕，及时行系统评估及综合治疗。

Abstract

Objective The objective of this study was to analyse the clinical and pathological characteristics of external nasal lesions, and to explore the associations of pathological type, lesion location, and reconstructive method with prognosis. The ultimate aim of this study is to provide a reference for standardised diagnosis, treatment, and comprehensive reconstruction. Methods A retrospective analysis was conducted on patients with external nasal lesions who were treated in the department of otorhinolaryngology at Jiangsu Provincial People̓s Hospital from January 2019 to December 2025 and had pathological confirmation. The dataset encompasses variables such as patient sex, age, the nature of the lesion (non-neoplastic lesions, benign tumours, and malignant tumours), pathological type, lesion location, surgical approach, and postoperative reconstructive method. The analysis of prognosis was conducted in conjunction with follow-up data. The intergroup comparisons were conducted utilising the chi-square test, the Kruskal-Wallis test, and the Mann-Whitney U test. Results The study population comprised 129 patients with external nasal lesions, including 69 males (53.5%) and 60 females (46.5%), yielding a male-to-female ratio of 1.15∶1.00. The age of the subjects ranged from 6 to 99 years, with a mean of 60.02±16.73 years. The study identified a total of 14 non-neoplastic lesions, 32 benign tumours, and 83 malignant tumours. A statistically significant variation in the distribution of sexual activity was observed among the three distinct groups (χ²=8.22, P=0.016). A significant disparity in age distribution was observed among the non-neoplastic, benign, and malignant groups (χ²=23.12, P<0.001). Patients with malignant tumours were found to be significantly older than those with benign tumours (P<0.001). Among benign neoplasms, intradermal nevus was the most prevalent type (43.8%). The tumours were predominantly epidermal in origin, with basal cell carcinoma and squamous cell carcinoma accounting for 63.9% and 26.5% of cases, respectively. In general, external nasal lesions were most prevalent in exposed regions of the nose, such as the nasal ala and dorsum. The location of the lesions was not found to be significantly associated with the benignity or malignancy of the tumours (P>0.05). All patients underwent complete excision, followed by reconstruction with direct closure, nasolabial flap, forehead flap, or adjacent local flaps according to defect extent and the three-dimensional nasal structure. Conclusion The external nasal lesions observed in this cohort were predominantly present in older patients and were primarily malignant epithelial tumours, most commonly involving the nasal ala and nasal dorsum. In cases where lesions are suspected of malignancy or have ill-defined margins, it is imperative that they are meticulously excised. This should be followed by three-dimensional reconstruction and flap repair, with both function and aesthetics taken into consideration. Special types, such as lymphoma and soft tissue tumours, require increased clinical vigilance, timely systemic evaluation, and comprehensive treatment.

关键词

外鼻 / 皮肤肿瘤 / 手术修复 / 预后

Key words

External Nose / Skin Tumors / Surgical Reconstruction / Prognosis

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基金资助

北京白求恩公益基金(2023YWZJ006-ym)