恶性肿瘤切除后巨大腹壁缺损的修复

The prothesis of the immense abdominal wall defect after resection of malignant tumors

目的探讨原发于腹壁或侵犯腹壁的恶性肿瘤切除术后巨大腹壁缺损的修复方法。方法本组20例，腹壁恶性肿瘤12例，其中腹壁横纹肌肉瘤9例、恶性纤维组织细胞瘤3例；腹膜后及腹腔恶性肿瘤侵犯腹壁8例，其中腹膜后恶性肿瘤3例、横结肠癌1例、升结肠癌右半结肠切除术后2～3年局部复发3例、肾癌术后5年腹壁种植复发1例。采用自膨式聚丙烯和膨化聚四氟乙烯复合补片行修复手术。观察术后并发症、修复成功率。结果术后一期愈合20例，无皮下积液，无切口感染、裂开和切口疝发生，未见修补材料与肠管粘连，修复成功率100％。随访20例，随访时间6～18个月，平均随访（9．3±3．4）个月。补片与腹壁相容性良好，无局部炎症反应；均未发现材料与肠管粘连，无切口疝形成，腹壁修补区未见肿瘤复发。结论自膨式聚丙烯和膨化聚四氟乙烯复合补片具有抗张力强度大、良好的组织相容性、修补术后并发症少等特点，是一种良好的肿瘤切除后腹壁缺损修复材料。

Objective To evaluate the repair of the immense abdominal wall defect after resection of malignant tumours occurred primarily in the abdominal wall or that invaded the abdominal wall secondarily. Methods Among the 20 cases, 12 cases were of malignant tumours within abdominal wall （9 cases of rhabdomyosarcoma, 3 cases of malignant fibrous histocytoma） , 8 cases with the invasion of abdominal wall from malignant turnouts were of retroperitoneal or intraabdominal malignant tumors （3 cases with retroperitoneal malignant tumours, 1 case of transverse colon carcinoma, 3 eases with local recurrence in abdominal wall of ascending colon carcinoma undergoing right hemicolectomy 2 - 3 years ago, 1 case with abdominal wall implantation metastasis of renal carcinoma after resection 5 years ago ）. Abdominal wall defects left over by resection were repaired with polypropylene and expanded polytetrafluoroethylene （PP- ePTFE） mesh. The postoperative complication and healing rate were observed. Results Wounds healed by primary intension, with no subcutaneous hydrops, no incision infection, dehiscence and hernia, no intestinal adhesion in all cases. The rate of successful repairing for the abdominal defect was 100%. All patients were fo]lowed up, the meshes with no rejection, inflammation and incision heruia, no recurrence of turnout in the repaired abdominal wall. Conclusion The PP-ePTFE mesh is a favourable repairing material for the abdominal defect after tumour resection, with the advantages of strong tensility, good biocompatibility.