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韧带样型纤维瘤病根治性切除术后的腹壁重建:单机构病例系列及文献综述

Abdominal wall reconstruction after desmoid type fibromatosis radical resection: Case series from a single institution and review of the literature.

作者信息

Couto Netto S D, Teixeira F, Menegozzo C A M, Albertini A, Akaishi E H, Utiyama E M

机构信息

Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

Departament of Surgery, Division of Surgical Clinic III, Hospital das Clínicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

出版信息

Int J Surg Case Rep. 2017;33:167-172. doi: 10.1016/j.ijscr.2017.02.050. Epub 2017 Mar 1.

Abstract

BACKGROUND

Abdominal wall desmoid type fibromatosis management has been changing over recent years, from an aggressive approach towards a more conservative one. When radical resection is indicated, the surgical team faces the challenge of abdominal wall reconstruction, for which optimal technique is still debated. The present study reports the experience from a single center with abdominal closures after desmoid type fibromatosis resection.

MATERIAL AND METHODS

Retrospective analysis of patients who underwent abdominal wall closure after sporadic abdominal desmoid type fibromatosis radical resection from 1982 to 2013.

RESULTS

Twenty-seven patients were included, mean tumor diameter was 10 + 5.3 cm, and the main choice of abdominal wall reconstruction was midline closure with anterior rectus sheath relaxing incisions and polypropylene onlay mesh (74% of the cases). Only 7% of the cases required more complex procedures for skin closure. Mean follow-up was 5 years and 89% remained disease-free. No grade 4 or 5 complications were observed.

CONCLUSION

High midline fascial closure rate can be achieved after resection of abdominal wall desmoid tumor using relaxing incisions and mesh, with low complication rate.

摘要

背景

近年来,腹壁硬纤维瘤型纤维瘤病的治疗方式已从积极治疗转向更为保守的治疗。当需要进行根治性切除时,手术团队面临腹壁重建的挑战,而最佳技术仍存在争议。本研究报告了单一中心在硬纤维瘤型纤维瘤病切除术后腹壁关闭的经验。

材料与方法

对1982年至2013年间因散发性腹壁硬纤维瘤型纤维瘤病根治性切除术后进行腹壁关闭的患者进行回顾性分析。

结果

纳入27例患者,肿瘤平均直径为10 + 5.3厘米,腹壁重建的主要选择是采用腹直肌前鞘松解切口和聚丙烯补片的中线关闭(74%的病例)。仅7%的病例需要更复杂的皮肤关闭手术。平均随访5年,89%的患者无疾病复发。未观察到4级或5级并发症。

结论

使用松解切口和补片切除腹壁硬纤维瘤后可实现较高的中线筋膜关闭率,且并发症发生率较低。

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