Yan Tristan, Sugarbaker Paul
Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Tumori. 2008 May-Jun;94(3):309-13. doi: 10.1177/030089160809400304.
Diagnostic technologies which penetrate the abdominal wall in an attempt to definitively diagnose an intraabdominal malignancy by biopsy can contaminate the abdominal wall by cancerous cells. With follow-up these entrapped cancer cells may progress as an abdominal wall recurrence of the disease process. Frequently, laparoscopy is the definitive diagnostic study which results in the abdominal wall cancer progression.
We examined recurrences within the abdominal wall and attempted to establish a surgical approach to this problem which would maximize a functional result and minimize the incidence of disease persistence within the abdominal wall.
Eighteen patients with abdominal wall recurrence were studied. Laparoscopy port sites resulted in the abdominal wall disease in eight patients, in four the recurrence was at a previous ostomy site, in three it was in a Pfannenstiel incision and in three it was in a McBurney incision site. All of these patients were treated by total resection of the rectus abdominis muscle. This resulted in a complete removal of visible disease that was dissecting along the fibers of the rectus abdominis muscle.
No patients required reoperation for abdominal wall hernia and mesh repair was not used in any of these patients. Disease control within the abdominal wall has been excellent.
通过活检试图明确诊断腹内恶性肿瘤的穿透腹壁的诊断技术可能会被癌细胞污染腹壁。随着随访，这些被困的癌细胞可能会发展为疾病过程的腹壁复发。通常，腹腔镜检查是导致腹壁癌进展的确定性诊断研究。
我们检查了腹壁内的复发情况，并试图建立一种针对该问题的手术方法，该方法将使功能结果最大化，并将腹壁内疾病持续存在的发生率降至最低。
研究了18例腹壁复发患者。腹腔镜检查端口部位导致8例患者出现腹壁疾病，4例复发发生在先前的造口部位，3例发生在耻骨联合上横切口，3例发生在麦氏切口部位。所有这些患者均接受了腹直肌全切除术治疗。这导致完全清除了沿腹直肌纤维扩散的可见疾病。
没有患者因腹壁疝需要再次手术，并且这些患者均未使用补片修补。腹壁内的疾病控制效果极佳。
