Rectus Abdominis Myocutaneous Flap for a Large Epigastric Soft Tissue Defect Following Resection of a Needle Tract Implanted Hepatocellular Carcinoma-A Case Report

台灣是B型肝炎帶原高盛行率的地區。B型肝炎帶原已經被證實是肝細胞癌的主要危險因子。在追蹤期間，常需對結節細針抽吸甚至以切片槍進行組織切片檢查，已鑑別診斷是否已進展至肝癌階段。我們報告一個58歲罹患肝細胞癌的男性在做完肝臟腫瘤細針抽吸檢查的數個月後，發現上腹部出現一個約3.5公分轉移性腫塊。我們為這位病人安排了肝臟之S3肝癌腫瘤切除合併腹壁腫瘤廣泛性全切除，但是太大的腹部缺口以致於無法直接逢合關閉。於是選取腹直肌皮瓣移植來作腹壁重建。腹直肌皮瓣是以superior or inferior epigastric artery為主莖根(pedicle) 動脈，含腹直肌肉及皮膚之皮瓣。此皮瓣常用於乳癌切除後之胸壁重建，很少被提到用來修補腹壁大缺口，或是腹股溝處、會陰處大缺口。此皮瓣可提供大量肌肉及膚色相近皮膚，供上述地區癌症病炤或淋巴轉移病炤，進行大規模切除後之重建手術所需。此皮瓣取得之技術已臻成熟穩定，手術成功率極高，美容外觀佳，常見之副作用包括：邊緣黑死，皮辦感染，或seroma形成。這些副作用都屬輕微，多可以保守方式處理。本病人術後恢復非常良好，腹部活動並沒有因此受到限制。術後兩年長期追蹤之腹部電腦斷層攝影並無腹壁癌腫瘤再發，病患對此手術之滿意度高。由於病患身材壯碩，為預防可能之切口疝氣發生，故以人工網膜加強。在疑似肝細胞癌的病人行經皮細針抽吸檢查時應小心預防癌細胞延著抽吸管道的散播轉移。近來由於肝局部酒精注射及radiofrequency治療增加，一旦發生類似此病例的併發症，應積極治療，而腹直肌皮瓣移植是一個良好的選擇。

關鍵字

肝癌；皮膚移轉；針吸細胞檢查

並列摘要

A 58-year-old man with a diagnosis of hepatocellular carcinoma developed a palpable mass in his epigastric area. This mass was noted several months after a fine needle aspiration procedure for cytological diagnosis. En bloc excision of the 3.5cm cutaneous metastatic tumor was performed, but the epigastric defect was too large for primary closure. The abdominal rectus myocutaneous island pedicle flap was selected for reconstruction and mesh was utilized for repair donor site of the low abdominal wall. The wound healed properly and the patient did not experience any limitation of physical activity. Percutaneous needle biopsy of HCC should be performed carefully to avoid needle tract implantation. The abdominis rectus myocutaneous island pedicle flap seems to be an excellent choice in managing large abdominal wall defects in the epigastric area.

並列關鍵字

hepatocellular carcinoma ； cutaneous metastasis ； aspiration biopsy

國際替代計量

Rectus Abdominis Myocutaneous Flap for a Large Epigastric Soft Tissue Defect Following Resection of a Needle Tract Implanted Hepatocellular Carcinoma-A Case Report

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