ADDIN CNKISM.UserStyle手术切除联合一期腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的疗效

doi:10.3877/cma.j.issn.1674-392X.2019.06.008

中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 515 -518. doi: 10.3877/cma.j.issn.1674-392X.2019.06.008

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ADDIN CNKISM.UserStyle手术切除联合一期腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的疗效

罗文钦¹, 杨世炜¹, 谢妍妍¹, 雷文章¹, 伍兵², 王永¹^,^†(

)

^1. 610041　成都，四川大学华西医院胃肠外科
^2. 610041　成都，四川大学华西医院放射科

收稿日期:2019-09-12 出版日期:2019-12-18
通信作者: 王永
基金资助:
四川省卫生和计划生育委员会科研项目(150141); 四川省科技厅项目(2015JY0184); 吴阶平医学基金项目(320.6750.16207)

Clinical effect of surgical resection combined with single-stage preperitoneal mesh repair for abdominal desmoid fibromatosis

Wenqin Luo¹, Shiwei Yang¹, Yanyan Xie¹, Wenzhang Lei¹, Bing Wu², Yong Wang¹^,^†()

^1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
^2. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China

Received:2019-09-12 Published:2019-12-18
Corresponding author: Yong Wang
About author:
Corresponding author: Wang Yong, Email: wydoctorl974@aliyun.com

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罗文钦, 杨世炜, 谢妍妍, 雷文章, 伍兵, 王永. ADDIN CNKISM.UserStyle手术切除联合一期腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(06): 515-518.

Wenqin Luo, Shiwei Yang, Yanyan Xie, Wenzhang Lei, Bing Wu, Yong Wang. Clinical effect of surgical resection combined with single-stage preperitoneal mesh repair for abdominal desmoid fibromatosis[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(06): 515-518.

目的

探讨手术切除联合腹膜前间隙补片修补治疗腹壁韧带样纤维瘤的临床疗效。

方法

采用回顾性横断面研究方法，收集2005年4月至2018年7月四川大学华西医院收治的19例腹壁韧带样纤维瘤患者的临床资料，患者均行腹壁韧带样纤维瘤手术切除联合补片修补术。观察指标：（1）手术及术后情况：合并症、肿瘤大小、病理分型、住院时间、术后并发症情况；（2）随访情况：腹壁韧带样纤维瘤远期并发症情况及术后放化疗情况。采用电话、门诊或住院方式对患者进行为期12个月的随访，了解患者肿瘤复发及远期并发症发生的情况。随访时间截至2019年7月。

结果

所有患者均行根治性肿块切除术和腹壁修补术，未进行术后放化疗。4例免疫组化结果显示肿瘤细胞均呈β-catenin表达，SMA（＋）3例，Desmin（灶性＋）1例。无术后并发症，随访期间内无肿瘤复发，也无远期并发症发生；住院时间9～22 d，平均14.8 d。

结论

韧带样纤维瘤是一种交界性肿瘤，易复发，首选外科手术治疗，术中扩大切除，借助冰冻切片，保证切缘阴性。对于切除后造成的腹壁缺损，应对腹壁进行一期重建。

关键词: 腹壁韧带样纤维瘤, 外科手术, 腹壁重建

Objective

To investigate the clinical effect of surgical resection combined with single-stage preperitoneal mesh repair for abdominal desmoid fibromatosis.

Methods

The retrospective cross-sectional study was conducted. The clinical data of 19 patients with abdominal desmoid tumor who were admitted to the West China Hospital of Sichuan University from April 2005 to July 2018 were collected. Observation indicators: (1) surgical and postoperative situations: postoperative complications, tumor size, pathological type and duration of hospital stay; (2) follow-up situation: Radiochemotherapy and long-term complications of abdominal desmoid fibromatosis. Follow-up using telephone interview, outpatient examination and inpatient examination was performed to detect the recurrence and long-term complications for 12 months up to July 2019.

Results

All patients received surgical resection combined with single-stage preperitoneal mesh repair and were successfully followed up for 12 months, without radiochemotherapy. 4 cases showed positive expression of β-catenin. The positive expressions of SMA were showed in 3 patients. One case showed positive expression of Desmin. The duration of hospital stay was 14.8 (9 to22) days. There was no recurrence and long-term complications.

Conclusion

Abdominal desmoid fibromatosis is a kind of borderline tumor which can be treated as benign tumor. Surgical resections are recommended for patients with abdominal desmoid fibromatosis. Large surgical margin, frozen section and negative margin are the key points during the operation. The defect of abdominal wall should be reconstructed.

Key words: Abdominal desmoid tumors, Surgery, Reconstruction of abdominal wall

图1 术中所见

图2 切除的肿瘤组织

图3 使用补片修补腹壁

图4 患者术前CT影像，可见右侧腹直肌内占位性病变，病灶呈等密度影

图5 患者术后CT影像，可见占位性病灶已被切除

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