原发性腹壁肿瘤的微创手术治疗

摘要/Abstract

摘要：

原发性腹壁肿瘤约占所有软组织肿瘤的10%，根据其生物学行为可分为良性、恶性、交界性三种。不同类型的腹壁肿瘤在临床表现、病理特征和预后上存在显著差异。术前多学科团队的综合评估，包括病理学和影像学检查，对于制定个体化治疗方案至关重要。近年来，腹腔镜手术在腹壁肿瘤的切除和重建方面展现出诸多优势，尤其适用于深在和内生性肿瘤。相比传统开放手术，腹腔镜手术有效减少组织损伤，提高肿瘤切除的精准性，降低并发症发生率，加速病人术后恢复，并改善术后美容效果。然而，腹腔镜手术在腹壁肿瘤治疗中的长期疗效和适用范围仍需进一步的临床研究证实。

关键词:腹壁肿瘤,微创手术,腹腔镜,腹壁重建

Abstract:

Primary abdominal wall tumors constitute approximately 10% of the total spectrum of soft tissue tumors. Based on their biological characteristics, these tumors can be classified into three distinct categories: benign, malignant, and borderline. Different subtypes of abdominal wall tumors exhibit significant heterogeneity in clinical manifestations, pathological features, and prognostic outcomes. A comprehensive preoperative evaluation by a multidisciplinary team, incorporating both pathological and radiological assessments, is indispensable for tailoring individualized treatment strategies. In recent years, laparoscopic surgery has emerged as a promising modality for resection and reconstruction of abdominal wall tumors, particularly those deep-seated or intramural. Compared with conventional open surgery, laparoscopic surgery offers several advantages, including reduced tissue trauma, precise tumor resection, lower rate of postoperative complications, faster recovery, and enhanced cosmetic results. Nevertheless, the long-term efficacy and the breadth of applications of laparoscopic surgery in the management of abdominal wall tumors warrant further investigation through rigorous clinical trials.

Key words:Abdominal wall tumor,Minimally invasive surgery,Laparoscopy,Abdominal wall reconstruction

中图分类号:

韩海峰, 逯景辉. 原发性腹壁肿瘤的微创手术治疗[J]. 外科理论与实践, 2024, 29(04): 311-315.

HAN Haifeng, LU Jinghui. Treatment of primary abdominal wall tumorsviaminimally invasive surgery[J]. Journal of Surgery Concepts & Practice, 2024, 29(04): 311-315.

参考文献25

[1]	BRENNAN M F, ANTONESCU C R, MORACO N, et al. Lessons learned from the study of 10,000 patients with soft tissue sarcoma[J].Ann Surg,2014,260(3):416-421;discussion421-422.
[2]	赵刚, 彭林. 腹壁肿瘤的治疗原则[J].中华疝和腹壁外科杂志(电子版),2011,5(1):25-28.
	ZHAO G, PENG L. Principles of treatment of tumours of the abdominal wall[J].Chin J Hemia Abdominal Wall Surg(Electronic Edition),2011,5(1):25-28.
[3]	SMITH H G, TZANIS D, MESSIOU C, et al. The management of soft tissue tumours of the abdominal wall[J].Eur J Surg Oncol,2017,43(9):1647-1655. doi:S0748-7983(17)30451-1pmid:28528910
[4]	WINDER A A, DAVIES E, BAGUé S, et al.C9113 Neoplasms of the abdominal wall[M]// NANAVATIA J, NAGRALS, NUNDYS, et al.Abdominal Trauma, Peritoneum, and Retroperitoneum. Oxford: Oxford University Press,2022: 113-132.
[5]	KASPER B, BAUMGARTEN C, BONVALOT S, et al. Management of sporadic desmoid-type fibromatosis: a European consensus approach based on patients' and professionals' expertise - a sarcoma patients EuroNet and European organisation for research and treatment of cancer/soft tissue and bone sarcoma group initiative[J].Eur J Cancer,2015,51(2):127-136. doi:10.1016/j.ejca.2014.11.005pmid:25434922
[6]	COUTO NETTO S D, TEIXEIRA F, MENEGOZZO C A M, et al. Sporadic abdominal wall desmoid type fibromatosis: treatment paradigm after thirty two years[J].BMC Surg,2018,18(1):37. doi:10.1186/s12893-018-0367-6pmid:29879959
[7]	STILLER C A, TRAMA A, SERRAINO D, et al. Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project[J].Eur J Cancer,2013,49(3):684-695. doi:10.1016/j.ejca.2012.09.011pmid:23079473
[8]	KASPER B, BAUMGARTEN C, GARCIA J, et al. An update on the management of sporadic desmoid-type fibromatosis: a European consensus initiative between Sarcoma PAtients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG)[J].Ann Oncol,2017,28(10):2399-2408. doi:S0923-7534(19)34935-Xpmid:28961825
[9]	FIORE M, RIMAREIX F, MARIANI L, et al. Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment[J].Ann Surg Oncol,2009,16(9):2587-2593. doi:10.1245/s10434-009-0586-2pmid:19568815
[10]	BONVALOT S, TERNES N, FIORE M, et al. Sponta-neous regression of primary abdominal wall desmoid tumors: more common than previously thought[J].Ann Surg Oncol,2013,20(13):4096-4102.
[11]	STOJADINOVIC A, HOOS A, KARPOFF H M, et al. Soft tissue tumors of the abdominal wall: analysis of disease patterns and treatment[J].Arch Surg,2001,136(1):70-79.
[12]	TATTERSALL H L, BAIA M, MESSINA V, et al. Overall survival in abdominal wall sarcoma treated with curative intent surgery: a retrospective study from two European referral centres[J].J Surg Oncol,2022,126(2):365-371.
[13]	NEUBERG M, MIR O, LEVY A, et al. Surgical management of soft tissue tumors of the abdominal wall: a retrospective study in a high-volume sarcoma center[J].J Surg Oncol,2021,124(4):679-686. doi:10.1002/jso.26566pmid:34120344
[14]	宋致成, 杨建军, 顾岩. 腹腔镜下腹壁侵袭性纤维瘤的R0切除与一期腹壁重建[J].中华胃肠外科杂志,2018,21(11):1260.
	Song Z C, Yang J J, Gu Y. Laparoscopic R0 resection of an invasive fibroma of the abdominal wall with one-stage abdominal wall reconstruction[J].Chin J Gastrointest Surg,2018,21(11):1260.
[15]	CRAGO A M, DENTON B, SALAS S, et al. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis[J].Ann Surg,2013,258(2):347-353. doi:10.1097/SLA.0b013e31828c8a30pmid:23532110
[16]	NISHIDA Y, HAMADA S, SAKAI T, et al. Less-invasive fascia-preserving surgery for abdominal wall desmoid[J].Sci Rep,2021,11(1):19379. doi:10.1038/s41598-021-98775-2pmid:34588532
[17]	PENCAVEL T, STRAUSS D C, THOMAS J M, et al. The surgical management of soft tissue tumours arising in the abdominal wall[J].Eur J Surg Oncol,2010,36(5):489-495. doi:10.1016/j.ejso.2010.03.007pmid:20381991
[18]	HAN H, LI R, YANG S, et al. Surgical techniques and effectiveness of laparoscopic resection of abdominal wall desmoid-type fibromatosis and defect reconstruction: a single-center retrospective analysis[J].Hernia,2024,28(1):211-222.
[19]	刘雪峰, 韩海峰, 杨硕, 等. 腹腔镜腹壁侵袭性纤维瘤病切除联合腹壁重建:单中心经验总结[J].中华疝和腹壁外科杂志(电子版),2023,17(4):374-379.
	LIU X F, HAN H F, YANG S, et al. Laparoscopic tumor resection and immediate abdominal wall reconstruction for abdominal wall aggressive fibromatosis: a single-center experience[J].Chin J Hernia Abdom Wall Surg(Electronic Edition),2023,17(4):374-379.
[20]	李航宇. 从生物力学角度重新解读腹壁重建[J].中国实用外科杂志,2021,41(4):379-383.
	LI H Y. Reinterpretation of abdominal wall reconstruction from the perspective of biomechanics[J].Chin J Pract Surg,2021,41(4):379-383.
[21]	中华医学会外科学分会疝与腹壁外科学组. 腹腔内补片修补术中国专家共识(2022版)[J].中国实用外科杂志,2022,42(7):721-729.
	Hernia and Abdominal Wall Surgery Group of the Chinese Medical Association Surgical Branch. Chinese expert consensus on intraperitoneal onlay mesh(2022 edition)[J].Chin J Pract Surg,2022,42(7):721-729.
[22]	VAN HOEF S, TOLLENS T. Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach?[J].Hernia,2019,23(5):915-925. doi:10.1007/s10029-019-02031-6pmid:31456098
[23]	SCHOENMAECKERS E, STIRLER V, RAYMAKERS J, et al. Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia[J].JSLS,2012,16(1):85-88. doi:10.4293/108680812X13291597716104pmid:22906335
[24]	SCHMITZ J J, SCHMIT G D, ATWELL T D, et al. Percutaneous cryoablation of extraabdominal desmoid tumors: a 10-year experience[J].Am J Roentgenol,2016,207(1):190-195. doi:10.2214/AJR.15.14391pmid:27064168
[25]	BARROW E, NEWTON K, RAJASHANKER B, et al. Successful radiofrequency ablation of an anterior abdominal wall desmoid in familial adenomatous polyposis[J].Colorectal Dis,2013,15(3):e160-e163.