The Surgical Treatment for Abdominal Wall Hernia

1　ＴｈｅｓｕｒｇｉｃａｌｔｒｅａｔｍｅｎｔｆｏｒｔｈｅｒｅｃｕｒｒｅｎｔｇｒｏｉｎｈｅｒｎｉａｓＥｖｅｒｓｉｎｃｅｔｈｅａｄｖｅｎｔｏｆｅｌｅｃｔｉｖｅｓｕｒｇｉｃａｌｉｎｔｅｒｖｅｎｔｉｏｎｆｏｒｉｎｇｕｉｎａｌｈｅｒｎｉａｒｅｃｕｒｒｅｎｃｅｓｈａｖｅｂｅｅｎｏｂｓｅｒｖｅｄ .Ｉｎｄｅｅｄ ,ｍａｎｙｏｆｔｈｅｍｏｄｅｒｎｓｕｒｇｉｃａｌｔｅｃｈｎｉｑｕｅｓｆｏｒｈｅｒｎｉｏｒｒｈａｐｈｙｗｅｒｅｄｅｖｉｓｅｄｓｐｅｃｉｆｉｃａｌｌｙｔｏｍｉｎｉｍｉｚｅｒｅｃｕｒｒｅｎｃｅｒａｔｅｓ.Ｆｏｒｍ…     

腹壁纤维瘤病诊断和治疗的进展

腹壁纤维瘤病(fibromatosisofabdominalwall),又称腹壁韧带样瘤或硬纤维瘤（desmoidtumorofabdominalwall），是一种来源于腹壁筋膜或肌腱膜组织的良性肿瘤。此肿瘤少见，无包膜，易通过筋膜或腱膜表面侵袭周围组织，至今未见发生远处转移的报道。文献报道手术切除后复发率很高，约20%～45%[1]。因此认为其生物学行为是交界性肿瘤，复发与切除是否彻底有关，术后放疗对降低复发率很有帮助。发病情况腹壁纤维瘤病发病率仅占全部肿瘤的0.03%，占软组织肿瘤的3%，好发于腹壁任何部位，但以下腹部为多见[2～4]。1832年由Macfarlane首先报道[5]…     

探讨剖宫产术后腹壁切口子宫内膜异位症的治疗方法

目的：探讨腹壁子宫内膜异位症的临床特点、治疗方法和预防措施。方法：回顾性分析2008年～2010年本院收治的30例具有足月剖宫产史的手术病例,其中89．9％患者在月经期间腹壁肿物有周期性疼痛,就诊年龄（33．3±4．8）岁,就诊时距剖宫产（70．2±44．7）月。30例病例分为A实验组17例和B对照组13例,A实验组于腰硬联合麻醉下行病灶切除术,术后未应用治疗子宫内膜异位症方面药物;B对照组口服孕三烯酮2．5mg,每周2次,6个月,对所有患者在治疗后2年内每年随访2次,以评价治疗效果。结果：实验组术前诊断均与术后病理检查相符,术后无复发,术后切口均为Ⅰ期愈合,7d正常拆线出院。对照组7例发生闭经,1例存在肝功能损伤,实验组治愈率明显高于对照组,差异有统计学意义（P〈0．05）。结论：剖宫产术后腹壁切口子宫内膜异位症治疗首选手术切除,术前严格掌握剖宫产指征,术中认真操作是关键,同时提倡该种疾病以预防为主。     

巨大腹壁切口疝的现代外科治疗

腹壁巨大切口疝的修补是很困难的手术 ,在一些特殊的病例中 ,由于患者的全身情况严重恶化使得切口疝无法修补 ,如年老、病态性肥胖及呼吸功能严重紊乱的患者。近年来 ,随着生物材料在疝和腹壁外科的广泛应用 ,对巨大腹壁切口疝的治疗已取得了明显进展。1　定义巨大切口疝的定义通常是根据疝环直径的大小来确定。目前国内外对巨大切口疝的定义不完全一致 ,中华外科学会疝和腹壁外科学组的切口疝分类法 (2 0 0 1年草案 )中将疝环直径>5ｃｍ的疝定为巨大切口疝[1 ] ,Ｆｌａｍｅｎｔ等[2 ] 将疝环直径 >1 0ｃｍ的疝定为巨大切口疝 ,Ｓｃｈｕｍｐ…     

Abdominal Wall Defects

The frequent use of prenatal diagnostic techniques including ultrasound and maternal serum alpha-fetoprotein has increasingly led to detection of abdominal wall defects before birth. This prenatal detection creates the opportunity to influence neonatal outcome by alteration in management of pregnancy or delivery. The optimal management of an individual fetus depends on careful prenatal assessment of the abdominal wall defect, combined with experience and knowledge of the natural history for that particular lesion. A multidisciplinary approach to the fetus can improve neonatal outcome. Careful assessment for other structural anomalies and karyotype analysis should be performed. Delivery at a high-risk perinatal center should be encouraged. Currently, there is no convincing evidence to support routine cesarean section for most abdominal wall defects.     

Abdominal Wall Schwannoma

Neurilemmomas—or schwannomas—are rare soft tissue tumours involving peripheral nerve sheaths, usually found in the head and neck regions. They can infrequently originate within the tissues of the abdominal wall. Here, we present a case of symptomatic schwannoma of the abdominal wall in a 62-year-old woman referred for abdominal pain in the right iliac fossa. On physical examination, a 5–7-cm oval-shaped area of consolidation with regular borders and elastic consistence was palpable. Ultrasound examination of the abdomen revealed a hypoechogenic mass measuring 80–33–42 mm; subsequently, a CT scan confirmed the presence of a well-circumscribed mass, with small calcifications inside. Radical excision of the lesion under general anaesthesia was performed, and the histological examination was consistent with the diagnosis of “ancient” schwannoma. The patient was discharged on the second postoperative day, and, at a clinical check 1 month postoperation, she reported no recurrence of abdominal pain and had an improved quality of life. Schwannomas have a good prognosis overall, with malignant degeneration being very rare. Local recurrence is plausible only if non-radical resection of the primitive tumour occurs. This is the second case ever reported, to our knowledge, of symptomatic schwannoma of the abdominal wall. We advocate surgical removal of the tumour when it presents as a cause of abdominal pain, ensuring that a radical excision is performed due to the possibility—though rare—of malignant transformation or recurrence. This offers the possibility of total regression of symptoms through surgical therapy.     

Primary Actinomycosis of the Abdominal Wall

A rare case of primary actinomycosis of the abdominal wall presenting as a tumour is described. The patient responded to penicillin therapy well. A brief account of the literature is included