肿瘤性腹壁缺损治疗体会(附17例报告)

Treatment experience on 17 cases of tumorous abdominal wall defects

目的探讨原发于腹壁或侵犯腹壁的恶性肿瘤切除术后腹壁缺损的修复方法。方法回顾性分析2006年7月至2012年1月沈阳市第四人民医院收治的17例肿瘤性腹壁缺损患者,3例患者采用直接缝合法,14例患者采用腹膜内无张力修补术,随访观察术后并发症及修复成功率。结果 17例患者中术后一期愈合14例,2例术后1周内出现皮下积液,穿刺抽液抗炎换药对症治疗2周后治愈,1例缺损直径<5cm但直接缝合张力小的病例采用直接缝合法,术后2个月出现切口疝,二期采用腹膜前无张力修补术治愈。一期修复成功率94.6%。随访17例(含1例二期采用腹膜前无张力疝修补术后始访),随访时间6～72个月,平均22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,无慢性疼痛及局部异物感。结论腹壁缺损直径<3cm的可采用最传统的单纯直接缝合法;3cm<缺损直径<5cm但直接缝合张力小的病例可采用单纯缝合法,但有发生术后切口疝风险,建议直接采用腹膜前非防粘连补片无张力修补术或腹膜内防粘连补片无张力修补术;5cm<缺损直径<10cm或缺损直径>10cm的巨大腹壁缺损建议直接采用腹膜内防粘连补片无张力修补术。

Objective To discuss the reasonable repair patterns of abdominal wall defect after resection of invasive tumors. Methods A prospectively analysis was made in 17 cases of tumorous abdomi- nal wall defects between July 2006 and January 2012. Three cases had direct sutures, and 14 cases with intra- peritoneal tension-free hernioplasty. The postoperative complications and healing rate were observed. Results Fourteen cases had primary recovery. Two cases had hypodermic hydrops after operation and recovered by symptomatic treatment. One case less than 5 cm who underwent direct suture showed incisional hernia after 2 months. The rate of primary recovery was 94.6%. During the follow-ups, the consistency of patch and abdom- inal wall was satisfied. There was no inflammation, adhesion, incisional hernia, relapse, chronic pain nor for- eign body sensation at the cuts. Conclusions The defect less than 3cm and the defect between 3cm and 5cm with small tension could take direct sutures, but with the risk of incisional hernia. The preperitoneal tension- free hernioplasty or intraperitoneal tension-free hernioplasty is the best repair pattern for this type. The defect more than 5cm should take intraperitoneal tension-free hernioplasty.