Objective: To explore the ideal procedure of excision and repair for giant desmoid in the abdominal wall and long-termed follow-up results. Methods: Clinical and follow-up data of 24 patients with giant desmoid in the abdominal wall underwent radical removal and immediate abdominal wall reconstruction in Diagnostic and Therapeutic Center of Hernia and Abdominal Wall Diseases, First Affiliated Hospital of People's Liberation Army General Hospital from October 2006 to October 2016 were analyzed retrospectively. Twenty-one female patients with the mean age of 34.6 years and 3 male patients with the mean age of 42.6 years were recruited. The minimal diameter of these tumors was 15 cm, and the maximal diameter was from xiphoid bone to pubic symphysis. Results: All of desmoids were removed radically and proved by the rapid pathologic examination. The size of abdominal wall defect after desmoids removal were 483 (21 cm×23 cm) to 2 100 cm(2) (35 cm×60 cm), averaged 945 cm(2) (27 cm×35 cm). All of defects were repaired with compound synthetic prosthesis using bridging procedure. Twenty-one patients were recovered smoothly and got primary wound healing. Three patients had prosthesis infected during 1 month postoperatively and 1 patient recovered with conservative therapy, the other 2 patients underwent infected prosthesis removal at 2 weeks and 3 months postoperatively, respectively. Twenty-two patients were followed up with the period of 12 to 121 months and the median period was 63 months. No marginal neoplasm recurrence, incisional hernia, and abdominal wall bulge happened. Eight patients developped fresh desmoids in the abdominal cavity or in the back. Two patients died because of intestinal obstruction due to desmoid infiltration, and the other 6 patients still survived along with stable desmoids. Conclusions: Radical removal for patients with giant desmoid in the abdominal wall is an ideal therapeutic method, and compound synthetic patch can be used to repair huge abdominal wall defect, even the defect compromised all of abdominal wall. The long-termed follow-up results showed these procedures had not put bad influence on the quality of patients' life.
目的： 探讨腹壁巨大硬纤维瘤的切除、修补方法及远期效果。 方法： 回顾性分析解放军总医院第一附属医院疝及腹壁外科诊疗中心2006年10月至2016年10月手术治疗的24例腹壁巨大硬纤维瘤患者的临床资料。女性21例，平均年龄34.6岁，男性3例，平均年龄42.6岁；肿瘤最小径均>15 cm。所有患者行根治性肿瘤切除及一期腹壁重建。 结果： 所有患者肿瘤成功切除，病理检查切缘阴性。肿瘤切除后腹壁缺损为483(21 cm×23 cm)～2 100 cm(2)(35 cm×60 cm)，平均945 cm(2)(27 cm×35 cm)。采用复合修补材料对腹壁缺损进行桥接式修补。21例患者术后恢复顺利，切口一期愈合。3例患者术后1个月内发生修补材料感染，1例经保守治疗痊愈，另2例分别在术后2周和3个月去除修补材料后切口愈合。22例患者获得完整随访资料，随访时间12～121个月，中位随访时间63个月。未发生切缘肿瘤复发、缺损修补区疝和膨出。8例患者于术后1～2年发生腹腔和背部硬纤维瘤，其中2例肿瘤生长迅速引起肠梗阻致死，其余6例患者带瘤生存，病情稳定。所有患者能正常生活和工作，大部分可参加适当运动。 结论： 对腹壁巨大硬纤维瘤行扩大手术切除可取得良好的根治效果，应用复合修补材料可修补大面积甚至全腹壁的肌筋膜缺损，且对患者的日常生活无明显影响。.
Keywords: Abdominal wall; Fibromatosis, aggressive; Prostheses and implants.