Ogawa Tatsuhiko
Intensive Care Unit, Kochi Health Sciences Center, Ike 2125-1, Kochi City, Kochi Prefecture, Japan.
J Med Case Rep. 2018 Feb 7;12(1):29. doi: 10.1186/s13256-018-1575-5.
Desmoid-type fibromatosis is characterized by desmoid tumors, which are benign soft tissue tumors that can be locally aggressive but typically do not metastasize. Desmoid tumors can manifest anywhere in the body, and those in the abdominal cavity account for approximately 30 to 50% of all such tumors. Complete resection with free margins has been the standard treatment, but non-surgical therapies have been implemented recently. However, if tumors are strongly invasive and/or persistently recur, radical surgical resection with free margins remains the primary treatment. Unfortunately, radical resection may cause large abdominal defects and hinder reconstruction. Several reports and recommendations have addressed this issue; however, to the best of our knowledge, few reports have described complete resection and the subsequent reconstruction of the rectus abdominis muscle.
A 35-year-old Asian woman presented at our hospital with a chief complaint of abdominal pain. She had abdominal desmoid tumors that required complete resection of her rectus abdominis muscle. Due to necrosis in her own reconstructed tissue, we failed to cover her anterior abdominal wall; thus, we used an abdominal binder as a substitute material to avoid exacerbating the incisional hernia and help her generate intra-abdominal pressure.
This case report may be informative and helpful for the treatment of patients with desmoid tumors, as managing desmoid-type fibromatosis is difficult.
韧带样型纤维瘤病以韧带样瘤为特征,韧带样瘤是一种良性软组织肿瘤,具有局部侵袭性,但通常不发生转移。韧带样瘤可出现在身体的任何部位,其中腹腔内的韧带样瘤约占所有此类肿瘤的30%至50%。切缘阴性的完整切除一直是标准治疗方法,但最近也采用了非手术治疗。然而,如果肿瘤具有强烈侵袭性和/或持续复发,切缘阴性的根治性手术切除仍是主要治疗方法。不幸的是,根治性切除可能导致大面积的腹部缺损并阻碍重建。已有多篇报道和建议涉及这一问题;然而,据我们所知,很少有报道描述腹直肌的完整切除及后续重建。
一名35岁的亚洲女性因腹痛为主诉前来我院就诊。她患有腹部韧带样瘤,需要完整切除腹直肌。由于自身重建组织坏死,我们未能覆盖其前腹壁;因此,我们使用腹带作为替代材料,以避免加重切口疝并帮助她产生腹内压。
本病例报告可能对韧带样瘤患者的治疗具有参考价值且有所帮助,因为韧带样型纤维瘤病的治疗颇具难度。