韧带样瘤切除术后的外科重建(附20例报告)

目的:探讨广泛手术切除和外科重建在治疗韧带样瘤中的作用。方法:回顾分析我院2009年至2011年间收治的20例行广泛手术切除和外科重建的韧带样瘤病人。腹壁韧带样瘤12例,腹壁外韧带样瘤8例;女16例,男4例,中位年龄30(12～47)岁。结果:20例中,除1例姑息性切除、1例因切缘较近直接缝合修复外,其余18例均接受外科广泛切除。18例根治性切除的病例中,2例直接修复,10例巴德补片修复,1例自体腹外斜肌腱膜修复,3例下肢纤维瘤病病人行人工血管置换或肌肉功能重建,2例肠系膜纤维瘤病行消化道重建。其中,5例病人作了术后放疗。随访19例病人均无瘤生存至今。结论:外科广泛切除和外科重建是治疗韧带样瘤的主要治疗方式;对切缘较近者可以补充放疗。

Analysis on surgical reconstruction of desmoid tumor after resection: 20 cases report

Objective To evaluate role of adequate resection and reconstruction in the treatment of desmoid tumor.Methods Twenty patients with aggressive fibromatosis,including 12 cases with desmoid tumor located at abdominal wall and 8 at extra abdominal wall,were operated at Fudan University Shanghai Cancer Center from 2009 to 2011.Among them,16 were females and 4 were males with a median age of 30(12-47) years.Results Eighteen patients received radically resection.One case received palliative resection and 1 case with a near edge resection.The wound was recovered with their own tissues in 2 cases,reconstructed with Bard composix mesh in 10 cases,with obliquus externus abdominis aponeurosis in 1 case.Three cases with lower limbs aggressive fibromatosis had man-made blood vessel replacement or function reconstruction.Two cases with mesentery fibromatosis had colon re-establishment.Radiotherapy was administered to 5 cases after resection.Nineteen cases lived without disease recurrence until the article finished.Conclusions Surgical resection with reconstruction is the therapeutic choice for desmoid tumor.Radiotherapy is an important compensatory way for patients with incomplete resection or near edge.