摘要
目的总结结直肠癌致腹壁巨大缺损一期修补的手术经验。方法回顾性分析2012年3月至2021年7月于北京大学首钢医院胃肠外科住院手术治疗的13例(男性10例,女性3例)腹壁受侵犯的原发或复发结直肠癌病例,总结分析其手术修补方式、手术时间、术中出血量、术后恢复时间、术区并发症及随访信息。结果腹壁肿瘤的最大直径约为15 cm,切除后的腹壁缺损平均约为15×15 cm2。腹壁组织的缺损修复,采用大腿外侧带蒂肌皮瓣2例,阔筋膜张肌筋膜皮瓣6例,腹壁筋膜皮瓣5例。有8例病例,应用了生物补片修补筋膜及腹膜缺损;2例病例因存在肿瘤部位的感染,采用了一期病灶切除并安装负压引流装置(vacuum sealing drainage,VSD),二期给予皮瓣移植修复。手术时间180~700 min不等,平均为275±36.62 min。术中平均出血量为247.6±22.44 ml。无围手术期死亡病例;1例病人出现皮瓣下脂肪液化;1例病人出现转移皮瓣坏死及感染。手术后留院时间10~34(19.23±5.89)d。术后2例存活不足1年,2例已经存活超过5年。结论对于腹壁巨大转移或受累的原发或复发性结直肠癌病例,多学科讨论后认为从技术和及肿瘤学层面可以从手术获益的病例,是否选择手术治疗需要谨慎的从肿瘤学、人文关怀、社会经济学等多个方面进行综合权衡。
Objective To study the feasibility and rationality of surgical treatment of abdominal wall defect caused by colorectal cancer.Methods From March 2012 to July 2021,13 cases(10 males and 3 females)of primary or recurrent colorectal cancer with large abdominal wall defects after surgery due to abdominal wall involvement were retrospectively analyzed.The age of the patients ranged from 28~78(52.6±3.87)years old.There were two cases of recurrent or metastatic tumors and one case of primary colon cancer with abdominal wall involvement.The time between recurrence and the first radical operation ranged from 0.5 to 8 years.The surgical repair method,operation time,intraoperative bleeding,postoperative hospital stay time,complications in the operation area,and follow-up information were recorded.Results The maximum diameter of abdominal wall tumor was about 15 cm,and the average are of the abdominal wall defects after resection was about 15 cm×15 cm2.The defect of abdominal wall tissue was repaired with the lateral thigh pedicled myocutaneous flap in two cases,the lateral thigh fasciocutaneous flap in six,and the abdominal wall fasciocutaneous flap in five.The biological patch(Cook)was used to repair the defect of the fascia and peritoneum in eight cases.Because of tumor site infection,two cases were treated with a two-step procedure.The lesions were resected and vacuum sealing drainage(VSD)was placed in the first step.And skin flap transplantation was performed after a week of draining.The operation time ranged from 180 to 700(275±36.62)minutes.The average intraoperative blood loss was(247.6±22.44)ml.The perioperative mortality rate is zero.One patient had subcutaneous fat liquefaction,while another had necrosis and infection of the transferred flap marginal area.All patients were discharged after 10~34(19.23±5.89)days after operation.Two patients survived for less than 1 year,while another two cases have survived for more than 5 years.Conclusion For cases of primary or recurrent colorectal cancer with huge metastasis or involvement of the abdominal wall,after multi-disciplinary discussion,the patients who can benefit from surgery from the aspects of technology and oncology should be carefully weighed from the aspects of oncology,humanistic care,social economics,etc.
作者
王延召
牛鹏飞
丁长民
高庆坤
高兆亚
安柯
翟志超
曾庆敏
黄文生
雷福明
顾晋
Wang Yanzhao;Niu Pengfei;Ding Changmin;Gao Qingkun;Gao Zhaoya;An Ke;Zhai Zhichao;Zeng Qingmin;Zeng Wensheng;Lei Fuming;Gu Jin(Department of Gastrointestinal Surgery,Peking University Shougang Hospital,Beijing 100144,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2023年第5期557-561,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
结直肠癌
腹壁缺损
整形修复
皮瓣移植
Colorectal cancer
Abdominal wall defect
Plastic repair
Flap transplantation
作者简介
作者邮箱:王延召,Email:wyz_8275@163.com
