成人腹壁硬纤维瘤切除术后腹壁组织修复重建的单中心临床研究经验

doi:10.3877/cma.j.issn.1674-392X.2023.05.008

目的

探讨成人腹壁硬纤维瘤手术切除及术后腹壁缺损修复重建的方法，总结分析其可行性，安全性及手术疗效。

方法

回顾性研究分析华中科技大学同济医学院附属武汉中心医院疝与腹壁外科2013年9月至2019年9月手术治疗的34例腹壁硬纤维瘤患者的临床病例资料。其中男性3例，女性31例；年龄21~78岁，平均（42.6±10.3）岁；均予以腹壁硬纤维瘤切除及腹壁缺损修复重建手术治疗。

结果

所有患者手术均顺利完成。34例患者病理学诊断均证实为腹壁硬纤维瘤，肿瘤切除后腹壁组织缺损直径大小（6.8±2.3）cm，范围为4~16 cm。术中无肠管及内脏损伤发生。术后疼痛需使用镇痛剂辅助治疗患者4例，使用时间3 d；术后住院时间3~9（4.8±1.2）d；术后3 d时所有患者均未见伤口感染及出血发生；术后随访2~24个月，所有患者均获随访，未见腹壁疝及肿瘤复发，未见慢性疼痛及补片感染发生；2年内死亡患者1例，死亡原因与腹壁硬纤维瘤疾病无关联。

结论

采用充分的切除，精细的解剖和分离技术，结合聚丙烯补片的应用，治疗腹壁硬纤维瘤是安全有效的。

关键词: 硬纤维瘤, 腹壁缺损, 腹壁重建, 聚丙烯补片

Objective

To investigate the feasibility, safety and operative effect of abdominal wall reconstruction for abdominal wall defect after surgical resection of adult abdominal desmoid tumor.

Methods

The clinical data of 34 patients with abdominal desmoid tumor who received operative treatment in Department of Hernia and Abdominal Wall Surgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from September 2013 to September 2019 were retrospectively analyzed. There were 3 males and 31 females, the average age was (42.6±10.3) years, ranging from 21 to 78 years. All patients received surgical resection of abdominal desmoid tumor and abdominal wall defect reconstruction.

Results

All patients received operations successfully. The pathological diagnosis was desmoid tumor for 34 patients. The diameter of abdominal wall defect after surgical resection was (6.8±2.3) cm, ranging from 4 to 16 cm. There was no damage with bowel and other organs during operation. Four patients need analgesics for 3 days for postoperative pain treatment. Postoperative hospital stay ranged from 3 to 9 (4.8±1.2) days. After operation, there was no postoperative infection and blood loss during the first three days. All patients were followed up for 2 to 24 months. No abdominal hernia, tumor recurrence, chronic pain or mesh infection. There was one death within 2 years, and the cause of death was not related to abdominal desmoid tumor.

Conclusion

Adequately resection, careful dissection and separation technique, combined with the application of polypropylene mesh for patients with adult abdominal desmoid tumor is safe and effective.

Key words: Desmoid tumor, Abdominal wall defect, Abdominal wall reconstruction, Polypropylene mesh

图1 腹壁硬纤维瘤手术过程及病理学、影像学表现注：1A术前细针穿刺病理检查提示黏液变性的硬纤维瘤（HE染色，×100）；1B腹腔镜探查，腹壁肿物突向腹腔，尚未突破腹膜侵犯腹腔脏器；1C手术完整切除肿瘤；1D使用补片对腹壁缺损进行一期腹壁重建；1E术后病理证实为硬纤维瘤并黏液变性坏死（HE染色，×100）；1F腹部CT平扫显示左侧腹直肌占位。

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Experience in single-center clinical studies of abdominal wall reconstruction after surgical resection of adult abdominal desmoid tumor

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Experience in single-center clinical studies of abdominal wall reconstruction after surgical resection of adult abdominal desmoid tumor