组织分离技术治疗腹壁肿瘤切除后腹壁缺损的疗效

Effect of component separation technique in the treatment of abdominal wall defect after resection of abdominal wall tumor

目的探讨组织分离技术(CST)治疗腹壁肿瘤切除后腹壁缺损的疗效。方法回顾性分析上海市同济医院和克拉玛依市中心医院普外科2016年1月至2019年1月收治的因腹壁肿瘤行CST手术治疗12例患者的临床资料。结果12例腹壁肿瘤患者均采用CST技术治疗。肿瘤病理类型以隆突性皮纤维肉瘤最多(4例),其次为硬纤维瘤(2例)和结肠癌腹壁转移(2例)。术前CT测量平均肿瘤最大横径(5.3±1.5)cm,肿瘤切除后平均腹壁缺损最大横径(9.4±1.4)cm。7例患者采用前入路CST(2例保留脐周腹壁穿支血管神经束,5例采用腹横肌松解技术)。10例患者使用合成补片,2例因为感染切口或联合肠管切除未使用补片。术后发生切口相关并发症3例,腹腔高压及肺不张1例,急性心肌梗死1例,均经保守治疗痊愈。1例患者于术后17个月死于结肠癌肝转移,其余11例无肿瘤复发,无腹壁切口疝发生。结论在保证充分切缘的前提下,在腹壁肿瘤患者中使用CST技术可以有效关闭缺损,重建腹壁功能,防止切口疝发生,是一种安全有效的方法。

Objective To evaluate component separation technique(CST)for the managetment of abdominal wall defect after resection of abdominal wall tumor.Methods Clinical data of 12 patients treated by CST form Jan 2016 to Jan 2019 at our two Hospitals were retrospectively analyzed.The abdominal wall defect after tumor radical resection were reconstructed with synthetic mesh.Results The most common pathological type was dermatofibrosarcoma protuberans(4 cases),followed by desmoid fibroma(2 cases)and abdominal metastasis of colon cancer(2 cases).The maximum diameter of tumor was(5.3±1.5)cm by CT preoperatively.The largest transverse diameter of abdominal wall defect after tumor resection was(9.4±1.4)cm.7 patients were treated with CST.10 patients used synthetic mesh.Incision-related complications occurred in 3 patients,abdominal hypertension and atelectasis in 1 case and acute myocardial infarction in 1 case.All patients were helped and discharged.One patient died of liver metastasis of colon cancer 17 months after operation,and the other 11 patients had no recurrence of tumor or incisional hernia.Conclusion Using CST in patients with abdominal wall tumor can effectively close the defect,reconstruct the function of abdominal wall and prevent the occurrence of incisional hernia.