Shiu M H, Weinstein L, Hajdu S I, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Am J Surg. 1989 Nov;158(5):446-51. doi: 10.1016/0002-9610(89)90284-5.
Malignant soft-tissue tumors of the abdominal wall consist of desmoid tumors and nondesmoid soft-tissue sarcomas. These neoplasms tend to invade adjacent musculoaponeurotic and bony structures. Transperitoneal organ invasion can also occur with devastating sequelae, especially after an incomplete excision. Extirpation with the full-thickness of the abdominal wall is required except for small, superficial lesions. A wide-margin resection, including any adherent viscus, segments of adjacent ribs, and iliac or pubic crest, offers the best assurance of local control. Adjunctive radiotherapy can be given when the margin of resection is unavoidably limited, but an effective radiation dose can be difficult to administer, due to the sensitivity of underlying intestines. Metastases develop frequently with high-grade sarcomas; adjuvant chemotherapy may be tried in these patients, but its value remains unproven.
腹壁恶性软组织肿瘤包括硬纤维瘤和非硬纤维瘤性软组织肉瘤。这些肿瘤倾向于侵犯相邻的肌筋膜和骨结构。经腹膜的器官侵犯也可能发生，并带来严重后果，尤其是在切除不完全之后。除了小的浅表病变外，需要切除全层腹壁。广泛切缘切除，包括任何粘连的脏器、相邻肋骨段以及髂嵴或耻骨嵴，能为局部控制提供最佳保证。当切除切缘不可避免地受到限制时，可以给予辅助放疗，但由于深部肠道的敏感性，可能难以给予有效的放疗剂量。高级别肉瘤经常发生转移；对于这些患者可以尝试辅助化疗，但其价值尚未得到证实。
