中南大学湘雅二医院 普通外科，湖南 长沙 410011
Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
背景与目的 侵袭性纤维瘤病（AF）是一种临床较为罕见的交界性肿瘤，一般不具备远处转移能力，具有局部侵袭特性，复发率较高。对于腹壁型AF而言，根治性切除意味着腹壁完整性的破坏，切除肿瘤后的腹壁重建处理较为棘手。本研究探讨根治切除联合人工材料桥接治疗腹壁型AF的安全性和疗效。方法 回顾性分析2013年1月—2021年10月中南大学湘雅二医院普外老年外科收治的16例腹壁型AF患者的临床及随访资料。所有患者均行腹壁病灶一期根治性切除，并同期采用人工材料桥接的方式修复腹壁缺损。结果 16例患者平均手术时间98（70~235）min，肿瘤平均长径8.6（4~14）cm，肿瘤切除后腹壁缺损6 cm×8 cm~14 cm×19 cm。腹壁缺损采用人工材料修复重建，6例采用sublay桥接，9例采用腹膜内补片桥接，1例紧贴耻骨病例采用立体桥接。所有手术均顺利完成。术后病理报告均为AF，其中唯一男性患者检测到CMNNB1基因外显子3（T41A）突变。1例患者出现术后血清肿，开放伤口后行封闭负压辅助闭合技术（VAC）治疗，行二期缝合后治愈。余15例患者无伤口感染、补片感染、肠梗阻等严重术后并发症，伤口甲级愈合出院。中位随访46（12~110）个月，随访率100%，未见肿瘤复发，无慢性疼痛、补片感染、补片膨出及切口疝发生。结论 腹壁型AF可发生于腹壁肌层的不同部位，以局部包块为主要表现，手术是主要治疗方式。完整切除肿瘤和保证阴性切缘可以有效避免肿瘤的复发，根治切除手术前应充分评估肿瘤大小、侵犯层面、缺损部位及范围，设计个体化手术方式，可有效达到腹壁形态和功能的重建。根治切除联合人工材料桥接修复切除后腹壁缺损治疗腹壁型AF安全有效。
Background and purpose Aggressive fibromatosis (AF) is a relatively rare borderline tumor with a tendency for local invasion but generally lacking distant metastasis. It is associated with a high recurrence rate. For patients with abdominal wall AF, achieving radical resection often requires disrupting the integrity of the abdominal wall, making abdominal wall reconstruction after tumor resection a challenging task. This study was performed to investigate the safety and efficacy of radical resection combined with artificial material bridging for the treatment of abdominal wall AFMethods The clinical and follow-up data of 16 patients with abdominal wall AF treated in the Department of Geriatric Surgery, the Second Xiangya Hospital of Central South University, from January 2013 to October 2021 were retrospectively analyzed. All patients underwent one-stage radical resection of the abdominal wall lesion and simultaneous repair of the abdominal wall defect with artificial material bridging.Results The average operative time for the 16 patients was 98 (70-235) min, and the average tumor size was 8.6 (4-14) cm. After tumor resection, abdominal wall defects ranged from 6 cm × 8 cm to 14 cm × 19 cm. Abdominal wall defects were repaired and reconstructed using artificial materials, with 6 cases using sublay bridging, 9 cases using IPOM bridging, and 1 case using three-dimensional bridging. All surgeries were completed successfully. Postoperative pathology reports confirmed AF in all cases, with one male patient showing a CMNNB1 exon 3 (T41A) mutation. One patient developed postoperative seroma, which was successfully treated with vacuum-assisted closure (VAC) after open wound management, and healed after secondary closure. The remaining 15 patients experienced no serious postoperative complications, such as wound infections, mesh infections, or intestinal obstruction, and were discharged after achieving grade I wound healing. The median follow-up period was 46 (12-110) months, with a 100% follow-up rate. No tumor recurrence, chronic pain, mesh-related infections, mesh protrusion, or incisional hernia occurred during the follow-up period.Conclusion Abdominal wall AF can occur in different parts within the muscle layer of the abdominal wall and typically presents as a local mass. Surgical treatment is the primary therapeutic approach. Complete tumor resection with negative margins effectively prevents tumor recurrence. Therefore, preoperative assessment of tumor size, depth of invasion, defect location, and extent is crucial for designing individualized surgical approaches to achieve effective abdominal wall reconstruction in terms of both form and function. Radical resection combined with artificial material bridging repair for post-resection abdominal wall defects is a safe and effective treatment for abdominal wall AF.