Kitasato Kenjiro, Kano Nobuyasu, Azuma Masaki, Kawakami Hideyuki, Murata Ippei, Ikota Masanori, Ohta Tomoyuki, Kobayashi Yukari, Tsuruta Yoshihiko
Dept. of Surgery, Chiba Tokushukai Hospital.
Gan To Kagaku Ryoho. 2020 Feb;47(2):331-333.
A 73-year-old man was admitted with the chief complaint of upper abdominal discomfort.After close examination, he was diagnosed with a huge stomach gastrointestinal stromal tumor(GIST)that occupied the upper left abdomen with a maximum diameter of 150 mm.The patient was referred to our department for surgery.The border between the tumor and spleen was unclear on CT images.As the diaphragm was thinned due to compression by the tumor, gastrectomy with splenectomy and partial resection of the diaphragm was planned.For the diaphragmatic defects, a simple closure was considered at first. However, artifacts have a high risk of infection when the defect holes are too large.Therefore, in this case, we attempted to repair the diaphragm hole with the autologous fascia lata.Intraoperatively, while the tumor was resected with 1 more layer of the diaphragm, the diaphragm itself was thinned, resulting in a defect hole of about 60×80 mm.Therefore, an 80×110mm fascia lata was harvested, and the diaphragm was repaired.Fascia lata can be conveniently harvested as a free graft.In addition, the fascia of the thigh has the advantage of being more resistant to infection than artificial materials.In addition, there was no functional failure due to collection, and special plastic surgery techniques and tools were unnecessary.Thus, it is a useful reconstruction material for general surgeons.Here we report the details of the surgery along with a review of the literature.
一名73岁男性因上腹部不适为主诉入院。经过仔细检查，他被诊断为巨大胃胃肠道间质瘤（GIST），占据左上腹，最大直径为150毫米。该患者被转诊至我科进行手术。CT图像显示肿瘤与脾脏之间边界不清。由于肿瘤压迫导致膈肌变薄，计划行胃切除术、脾切除术及部分膈肌切除术。对于膈肌缺损，起初考虑简单缝合。然而，当缺损孔过大时，人工补片有较高的感染风险。因此，在本病例中，我们尝试用自体阔筋膜修复膈肌孔。术中，在切除肿瘤时连同膈肌多切除一层，膈肌本身变薄，形成约60×80毫米的缺损孔。于是，切取一块80×110毫米的阔筋膜，对膈肌进行修复。阔筋膜可方便地作为游离移植物切取。此外，大腿筋膜比人工材料更抗感染。另外，取材后无功能障碍，无需特殊的整形手术技术和工具。因此，它是普通外科医生有用的重建材料。在此我们报告该手术细节并复习相关文献。
