内容紹介
Summary
A 73-year-old man was admitted with the chief complaint of upper abdominal discomfort. After close examination, he was diagnosed with a huge stomach gastrointestinal stromal tumor(GIST)that occupied the upper left abdomen with a maximum diameter of 150 mm. The patient was referred to our department for surgery. The border between the tumor and spleen was unclear on CT images. As the diaphragm was thinned due to compression by the tumor, gastrectomy with splenectomy and partial resection of the diaphragm was planned. For the diaphragmatic defects, a simple closure was considered at first. However, artifacts have a high risk of infection when the defect holes are too large. Therefore, in this case, we attempted to repair the diaphragm hole with the autologous fascia lata. Intraoperatively, while the tumor was resected with 1 more layer of the diaphragm, the diaphragm itself was thinned, resulting in a defect hole of about 60×80 mm. Therefore, an 80×110 mm fascia lata was harvested, and the diaphragm was repaired. Fascia lata can be conveniently harvested as a free graft. In addition, the fascia of the thigh has the advantage of being more resistant to infection than artificial materials. In addition, there was no functional failure due to collection, and special plastic surgery techniques and tools were unnecessary. Thus, it is a useful reconstruction material for general surgeons. Here we report the details of the surgery along with a review of the literature.
要旨
症例は73歳,男性。上腹部の違和感を主訴に受診した。最大径150 mm大で左上腹部を占拠する巨大胃gastrointestinal stromal tumor(GIST)の診断となり,手術目的で当科紹介となった。CT上脾臓との境界は不明瞭で横隔膜も菲薄化しており,脾・横隔膜合併噴門側胃切除術を予定した。横隔膜欠損に対し可能なら単純閉鎖を考えていたが,欠損孔が大きくなった際に人工物では感染のリスクが高いため,自己大腿筋膜による修復を企図した。術中は横隔膜を腫瘍に一層つける形で切除を行ったが横隔膜は菲薄化しており,60×80 mmの欠損孔となった。このため右大腿から80×110 mm大の大腿筋膜を採取し修復した。大腿筋膜は遊離移植片として簡便に採取でき,人工材料に比較して感染に強いというメリットを有している。採取による機能障害もなく,形成外科の特殊な手技や道具も不要であり,一般外科医にとって有用な再建材料であると考えられたため文献的考察を加え報告する。
目次
A 73-year-old man was admitted with the chief complaint of upper abdominal discomfort. After close examination, he was diagnosed with a huge stomach gastrointestinal stromal tumor(GIST)that occupied the upper left abdomen with a maximum diameter of 150 mm. The patient was referred to our department for surgery. The border between the tumor and spleen was unclear on CT images. As the diaphragm was thinned due to compression by the tumor, gastrectomy with splenectomy and partial resection of the diaphragm was planned. For the diaphragmatic defects, a simple closure was considered at first. However, artifacts have a high risk of infection when the defect holes are too large. Therefore, in this case, we attempted to repair the diaphragm hole with the autologous fascia lata. Intraoperatively, while the tumor was resected with 1 more layer of the diaphragm, the diaphragm itself was thinned, resulting in a defect hole of about 60×80 mm. Therefore, an 80×110 mm fascia lata was harvested, and the diaphragm was repaired. Fascia lata can be conveniently harvested as a free graft. In addition, the fascia of the thigh has the advantage of being more resistant to infection than artificial materials. In addition, there was no functional failure due to collection, and special plastic surgery techniques and tools were unnecessary. Thus, it is a useful reconstruction material for general surgeons. Here we report the details of the surgery along with a review of the literature.
要旨
症例は73歳,男性。上腹部の違和感を主訴に受診した。最大径150 mm大で左上腹部を占拠する巨大胃gastrointestinal stromal tumor(GIST)の診断となり,手術目的で当科紹介となった。CT上脾臓との境界は不明瞭で横隔膜も菲薄化しており,脾・横隔膜合併噴門側胃切除術を予定した。横隔膜欠損に対し可能なら単純閉鎖を考えていたが,欠損孔が大きくなった際に人工物では感染のリスクが高いため,自己大腿筋膜による修復を企図した。術中は横隔膜を腫瘍に一層つける形で切除を行ったが横隔膜は菲薄化しており,60×80 mmの欠損孔となった。このため右大腿から80×110 mm大の大腿筋膜を採取し修復した。大腿筋膜は遊離移植片として簡便に採取でき,人工材料に比較して感染に強いというメリットを有している。採取による機能障害もなく,形成外科の特殊な手技や道具も不要であり,一般外科医にとって有用な再建材料であると考えられたため文献的考察を加え報告する。