目的 探讨腹壁侵袭性纤维瘤病（AF）的临床特征以及根治性手术切除的治疗效果。方法 回顾性分析2011年1月至2024年1月山东省立医院胃肠外科收治的80例腹壁AF病人的临床及随访资料，并对其手术情况、近远期疗效、病理特征、复发影响因素等进行统计分析。结果 4例（5%）病人行单纯肿瘤切除，69例（86.25%）病人行根治性肿瘤切除+腹壁重建术，5例（6.25%）病人行肿瘤联合器官切除+腹壁重建术，2例病人行肿瘤切除+自体组织移植+腹壁重建术。手术时间为165（25~725）min，术中失血量为35（5~250）mL。术后2例（2.5%）病人发生腹壁感染，3例（3.75%）发生腹壁疝或腹壁膨出。术后中位随访时间为60（7~163）个月。复发3例，复发率为3.8%。所有病人中63例完成腹壁功能分级评分，87.3%的病人无明显体力活动受限（腹壁功能分级为4或5级）。1例（1.25%）病人因多次手术后肿瘤迅速增大侵犯腹腔内多器官而死亡。复发型AF和切缘阳性与术后复发显著相关（P＜0.05）；多因素分析结果显示，复发型AF是术后再次复发的独立危险因素（P=0.011）。
结论 腹壁AF好发于青年女性，且多数有腹部手术史，复发型AF术后易再复发；根治性手术切除联合腹壁重建是治疗腹壁型AF的安全、可行方法。
Abstract
To investigate the clinical features and the efficacy of radical surgical resection in the treatment of aggressive fibromatosis (AF) of abdominal wall. Methods The clinical and follow-up data of 80 patients with AF of abdominal wall admitted to the Department of Gastrointestinal Surgery of Shandong Provincial Hospital between January 2011 and January 2024 were retrospectively analyzed, and the surgical details, short- and long-term outcomes, pathological features, and factors associated with recurrence were statistically analyzed. Results Four patients (5%) underwent simple tumor excision, 69 patients (86.25%) underwent radical tumor resection plus abdominal wall reconstruction, 5 patients (6.25%) underwent combined tumor and organ resection plus abdominal wall reconstruction, and 2 patients underwent tumor resection plus autologous tissue transplantation plus abdominal wall reconstruction. The operative time was 165 (25-725) minutes, and intraoperative blood loss was 35 (5-250) mL. Postoperatively, 2 patients (2.5%) developed abdominal wall infection, and 3 patients (3.75%) developed abdominal wall hernia or bulging. The median postoperative follow-up was 60 (7-163) months. Three patients experienced recurrence, for a recurrence rate of 3.8%. Among all patients, 63 completed abdominal wall function grading, and 87.3% had no obvious limitations in physical activity (abdominal wall function grade 4 or 5). One patient (1.25%) died due to rapid tumor enlargement invading multiple intra-abdominal organs after multiple surgeries. Recurrent-type AF and positive surgical margins were significantly associated with postoperative recurrence (P<0.05); multivariable analysis indicated that recurrent-type AF was an independent risk factor for postoperative re-recurrence (P=0.011). Conclusion Abdominal wall AF is more common in young women, with most patients having a history of abdominal surgery. Recurrent cases are prone to postoperative recurrence. Radical surgical resection combined with abdominal wall reconstruction is a safe, feasible and reliable method for the treatment of abdominal wall AF.
关键词
侵袭性纤维瘤病 /
腹壁 /
手术 /
复发
Key words
aggressive fibromatosis /
abdominal wall /
surgery /
recurrence
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