Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan.
J Gynecol Oncol. 2023 Jul;34(4):e43. doi: 10.3802/jgo.2023.34.e43. Epub 2023 Feb 1.
Cytoreductive surgery for patients with advanced ovarian cancer often requires full-thickness resection of the diaphragm [1]. In most cases, the diaphragm can be closed directly; however, when the defect is wide and simple closure is difficult, reconstruction using a synthetic mesh is usually performed [2]. However, the use of this type of mesh is contraindicated in the presence of concomitant intestinal resections because of the risk of bacterial contamination [3]. Autologous tissue shows a higher resistance to infection than artificial materials [4]; thus, we introduce diaphragm reconstruction using autologous fascia lata during cytoreduction for advanced ovarian cancer. A patient with advanced ovarian cancer underwent right diaphragmatic full-thickness resection with concomitant resection of the rectosigmoid colon, and complete resection was achieved. The defect of the right diaphragm measured 12×8 cm, and direct closure was impossible. A section of the right fascia lata measuring 10×5 cm was harvested and sutured to the diaphragmatic defect with a 2-0 proline continuous suture. The harvesting of the fascia lata required only 20 minutes, with little blood loss. No intraoperative or postoperative complications were experienced, and adjuvant chemotherapy was initiated without any delay. Diaphragm reconstruction with the fascia lata is a safe and simple method, and we propose this reconstruction technique especially for patients with advanced ovarian cancer who undergo concomitant intestinal resections. The informed consent for use of this video was taken from the patient.
对于晚期卵巢癌患者，细胞减灭术常常需要对膈肌进行全层切除[1]。在大多数情况下，膈肌可以直接缝合；然而，当缺损较宽且单纯缝合困难时，通常采用合成网片进行重建[2]。然而，当存在同时进行肠切除术时，由于存在细菌污染的风险，这种类型的网片是禁忌的[3]。自体组织比人工材料具有更高的抗感染能力[4]；因此，我们在进行晚期卵巢癌细胞减灭术中引入了使用自体阔筋膜重建膈肌的方法。一名晚期卵巢癌患者接受了右膈肌全层切除和乙状结肠直肠切除术，实现了完全切除。右侧膈肌缺损为 12×8cm，直接缝合不可能。切取 10×5cm 的一段右侧阔筋膜，用 2-0 聚赖氨酸连续缝线缝合膈肌缺损。阔筋膜的切取仅需 20 分钟，出血量很少。术中及术后均未出现并发症，无任何延迟，立即开始辅助化疗。阔筋膜重建膈肌是一种安全简单的方法，我们建议将这种重建技术特别应用于同时进行肠切除术的晚期卵巢癌患者。使用该视频已获得患者的知情同意。
