医源性肿瘤腹壁种植转移五例分析

atrogenic abdominal wall implantation and metastasis from the malignant tumors: an analysis of five cases

目的探讨医源性肿瘤腹壁种植转移的诊断和治疗。方法结合文献回顾性分析5例医源性肿瘤腹壁种植转移患者的临床诊疗过程及转归。结果5例患者中，原发癌为胆管癌1例，肝癌4例。分别于医源性操作后42～94d发现腹壁种植转移，1例患者半年后因恶液质去世，种植转移灶较前稍增大；2例肝癌TACE治疗的同时给予种植转移灶TACE治疗，2例种植转移灶给予局部放疗，4例患者转移灶均稳定．TACE及放疗各有1例患者出现局部皮肤损伤。结论医源性诊疗操作存在一定程度的肿瘤腹壁种植转移的风险，结合病史、影像学、细胞学及病理检查可明确诊断，局部治疗具有一定优势，但对于终末期患者在转移灶不影响生活质量的前提下可暂时给予观察。

Objective To discuss the diagnosis and treatment of iatrogenic abdominal wall implantation and metastasis from malignant tumors. Methods Combined with literature review, the clinical data, including diagnosis, treatment course and outcomes, of five patients with iatrogenic abdominal wall implantation and metastasis from malignant tumors were retrospectively analyzed. Results The primary malignancies in the five patients included cholangiocarcinoma （n = 1） and hepatic carcinoma （n -- 4）. The abdominal wall implantation and metastasis from the primary malignant tumors occurred in the period varying from 42 to 94 days after the operative management. One patient died six months later due to cachexia, with the metastatic lesions becoming a little bit larger than before. TACE was employed in two patients with hepatic carcinoma to deal with the primary tumor as well as the abdominal wall implantation and metastasis lesions. Local radiotherapy was used in two patients for the abdominal wall implantation and metastasis lesions. All the metastasis lesions in the four patients were kept in stable condition. Local skin injury was seen in two patients. Conclusion Clinical operative management carries a certain degree of risk in producing iatrogenic abdominal wall implantation and metastasis from primary malignant tumors. The diagnosis can be easily clarified when the medical history, imaging features, cytological and pathological findings are altogether taken into account. Local therapy has certain advantages. For patients in terminal stage with metastasis lesions that do not affect the living quality, the temporal measure of simple observation is recommended.