胃肠道癌术后腹壁创口种植瘤的临床分析

Clinical analysis of implantation metastasis carcinoma of abdomial wound in postoperative gastrointestinal cancer

目的:探讨胃肠道癌术后腹壁创口种植瘤的临床特征、诊断、治疗及预后。方法:回顾性分析川北医学院附属医院收治住院的14例胃肠道癌术后创口种植瘤患者临床资料,并进行相关文献复习。结果:发生腹壁种植瘤的原发性胃肠道癌分期均为T4期,64.3%(9/14)的病理组织类型为低分化腺癌,常规化疗9例。种植瘤发生于腹腔镜或开腹手术的比例均为50.0%(7/14),各有5例患者行了单纯的腹壁肿瘤切除、腹壁肿瘤切除+腹壁缺损补片修补术,2例单纯腹壁肿瘤切除的患者因全身扩散后分别于10、16个月后死亡,补片修补腹壁缺损的患者目前均处于生存状态(复发1例)。4例患者因腹壁肿瘤多发或扩散而放弃手术于12个月内死亡。结论:发生腹壁种植瘤的原发性胃肠道癌恶性程度高,分期晚,术后的常规化疗不能有效的预防创口种植瘤,在腹腔镜及开腹手术中均可发生。尚无其他部位广泛转移的创口种植瘤应尽早行足够范围的完整切除术,人工补片修补是治疗肿瘤切除后腹壁缺损的有效方式。

Objective：To investigate the clinical characteristics,diagnosis,treatment and prognosis of implantation metastasis carcinoma of abdominal wound in postoperative gastrointestinal cancer. Methods：Clinical data of 14 patients with implantation metastasis carcinoma of abdominal wound,who were admitted to Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. Results：The gastrointestinal cancers with developing to abdominal implantation metastasis carcinoma,stages were all T4 ,64. 3%（9 / 14）of the pathological types were poorly differentiated adenocarcinoma,and nine cases received routine chemotherapy. Abdominal implantation metastasis carcinoma occurred in the proportion of laparoscopy or laparotomy was 50. 0%（7 / 14）. There were 5 patients did simple abdominal tumor resection,and 5 cases underwent abdominal tumor resection and patch repair of abdominal wall defect,2 patients with pure abdominal tumor resection died respectively after 10,16 months of postoperation,due to the spread of cancer. Patients with patch repaired abdominal wall defects are currently living in a state（ recurrence 1 case）,Four patients give up surgery for abdominal tumor multiple or diffusion died within 12 months. Conclusion：The gastrointestinal cancers with developing to abdominal implantation metastasis carcinoma are high degree malignant and advanced stage,conventional chemotherapy after surgery can not effectively prevent abdominal implantation metastasis carcinoma,and it may occur in laparoscopic and open operation. Abdominal implantation metastasis carcinoma with no other extensive transfer should be a complete resection as early as possible,artificial patch repair is the treatment of abdominal wall defect after tumor resection is an effective way.