作者：Nai-Jen Chang, Shao-Chih Hsu, Chih-Wei Wang, Wei-Fan Chen, Ming-Mo Hou, Chih-Hung Lin.
文章發表：J Taiwan Soc of Plast Surg 2011;20:189-195.
大綱
一、背景：結締織維瘤是最常見的腹壁腫瘤。手術創傷如腹部及骨盆腔手術，或生理創傷如懷孕都是容易產生結締纖維瘤的危險因子。因此年輕女性在經歷剖腹產後得到此疾病是合理的推測。二、方法：1983年至2010年，九例腹壁結締纖維瘤病曾經接受剖腹產的病患被列入研究。所有的病例爲女性，平均年齡爲30.2歲。統計及分析研究的資料包含性別，年齡，剖腹產的次數和治療成果。三、結果：在所有九位病人當中，一位病人經歷了三次剖腹產，三位經歷了兩次，五位經歷了一次。所有的患者接受手術切除後邊緣均無腫瘤細胞且沒有術後併發症，只有一個病人後來復發並接受了再切除。四、結論：診斷結締纖維瘤需要術前病理的確認且排除全身性相關疾病。連帶周圍組織的切除是確保邊緣乾淨及復發的方法。如果傷口不能直接關閉，各種方式包括人工網的重建或自體組織重建都可以達到腹壁關閉的功能。
BACKGROUND:
Desmoid tumor is the most common abdominal wall tumor. It is frequently associated with either surgical trauma, such as abdominal or pelvic surgery, or physiologic trauma, such as pregnancy. So, Caesarean sections (C/S) is thought to be an important risk factor because it contains both factors.
METHODS:
Between 1983 and 2010, 9 cases of abdominal wall desmoid tumor with prior history of C/S were included in the study. All of the 9 patients were female with the mean age of 30.2 (ranging from 27 to 35-year-old). The demographic data including sex, age, history of previous C/S, and outcomes were analyzed.
RESULTS:
Between all the patients, one patient had three prior C/S; three patients had two and five patients had one. All of the patients received surgical excision with primary closure with clear margin. The postoperative courses were all smooth except one subsequently developed recurrence and underwent re-excision.
CONCLUSIONS:
Pre-operative biopsy to confirm the pathology and rule out the possibility of systemic disease is mandatory when making the diagnosis of desmoid tumor. Intervene the tumor concurrent with C/S or at postpartum period are both acceptable choices. One stage excision with wider margin and optional reconstructive modalities including mesh closure and autologous tissue reconstruction is the goal to achieve abdominal wall closure.
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