Clinical Analysis Of Surgical Treatment Of Glomus Tumor

Objective: Glomus tumor is a rare benign soft tissue tumor which can occur in the limbs,torso,neck and visceral,about 75% occur in the hand,accounting for tumor of soft tissue of hand 1-4.5%.Most of them are located under the nail(50%)[1].They are many unmyelinated nerve fiber and sympathetic nerve in glomus tumor.Patients often show signs of spontaneous pain,unbearable tenderness and sensitive to cold stimulation,seriously affected the normal life.Through the Love's pin test,Hildreth's test and Cold sensitivity test can make the diagnosis of most cases with MRI(Magnetic resonance imaging)and the X-ray can make a diagnosis of the vast the majority of patients.Conservative treatment can not get effective treatment,surgical resection is the only way to relieve or eliminate the pain,In this paper,we used Transungual approach and Lateral Subperiosteal approach surgical resection cases were retrospectively tudied.To explore the clinical therapeutic effect and pathogenesis.Methods: Collecting 35 patients with subungual glomus tumor microsurgery from February 2006 ~2015 year in July of the First Affiliated Hospital of Dalian Medical University,a total of 36 lesions(The postoperative pathology confirmed the diagnosis of glomus tumor),9 males and 26 females,1 case of multiple(thumb and index finger),the right hand incidence of 16,left onset in 19 cases,including 10 thumbs,8 index fingers,5 middle fingers,6 ring fingers and 7 pinky.The average age of 38 years(22~58 years),the average duration of 3.6 years(4 months ~20 years).The operation by hand surgery specialist under the microscope using Transungual approach and Lateral Subperiosteal approach,for the deeply located in the pulp of we used abdominal incision.To record the preoperative and postoperative with pain for 6 months,including occurrence and development situation of recurrence and postoperative deformity of the nail;1 months,3 months,6 months were followed up and recorded the main symptoms and signs,and postoperative average hospitalization time,and to use VAS score(mean visual analogue scale)to record the pain degree of the change of the patients before and after operation.According to scholars on the operation of Transungual approach and Lateral Subperiosteal approach treatment of glomus tumor curative effect,and clinical repeated recurrence and operation in multiple analysis of satellite lesions,we are gonging to study the mechanism of the occurrence and development of various treatment methods and the advantages and disadvantages of the glomus tumor.Results:Average hospitalization time of 4.2 days,a mean follow-up of 51 months(7~120 months)recurrence in 6 cases(3 cases of recurrence after surgery in our hospital,and the other 3 cases outside hospital postoperative recurrence in our hospital reoperation cases),in 6 cases of recurrence,we found that there are 2 pieces or more tumor was found in 3 patients,1 patient surgery three anatomical locations are not the same.In our hospital glomus tumor after operation recurrence rate was 8.6%(3 cases of recurrence in 35cases).Nail deformity 10 cases(nail deformity in 2 cases of longitudinal splitting,8 cases of nail mild indentation),Preoperative VAS score was 9.0(3-10),postoperative VAS scores at 1,3 and 6 months were respectively 0.7(0-5),0.7(0-10),0.5(0-10),postoperative 1 month subjective pain ease satisfaction rate of 100%,3 months and 6 months after subjective symptom remission in 34 cases(97%),invalid 1 case.In 29 cases of Transungual approach 10 cases had different degree of nail deformity.Lateral Subperiosteal approach was used in 4 cases without nail deformity,2 cases were treated by means of abdominal incision.Conclusions:1.recurrence may be associated with multiple glomus tumor of satellite lesions.2.surgical treatment of subungual glomus tumor can relief the subjective pain symptoms.3.surgical resection has a high recurrence rate,reduce the recurrence rate is our common pursuit of the goal.