腹白线疝内容物为肝圆韧带并发胃癌一例

A Case Report of the Round Hepatic Ligament Being as Contents of Linea Alba Associated with Gastric Cancer

摘要: 女性，70岁，主诉上腹壁包块60余年，上腹部隐痛1月余。查体：一般情况尚可，贫血貌，结膜苍白(++)，巩膜黄染(−)。上腹部正中可及一6 cm ×4 cm一包块，质软，不能回纳。腹部B超检查示：上腹部腹壁皮下深筋膜回声中断，有一个缺口约9 mm，其浅方可见一个53 mm ×20 mm×39 mm偏强回声团块，内见蠕动的肠管及网膜样组织，通过此缺口与腹腔相通，提示腹白线疝。腹部CT扫描提示：上腹前壁中线处皮下脂性团片影，考虑腹白线疝可能。胃镜检查：胃窦部见一个不规则隆起，大小约4 cm ×3.5 cm，表面溃烂，病理示：低分化腺癌。实验室检查：血红蛋白(Hb)73 g/L，癌胚抗原(CEA)3.0 ug/L。在硬膜外麻醉下行剖腹探查：术中见腹白线处有一个3 cm ×4 cm×4 cm肿块，边界清，淡黄色，质软，与肝圆韧带顺序相连；肿瘤位于胃窦部小弯侧后壁，Borromann3型，约5 cm × 4 cm大小，穿透浆膜面，故行“根治性胃远端大部切除(D2+)，腹白线疝修补术”，术后恢复顺利，痊愈出院。 A 70 year-old woman with chief complaint of an epigastric abdominal wall for more than 60 years, and dull pain in epigastria for 1 month. The general condition of this patient was good on physical examination, and patient was found with pale face and conjunctiva and negative yellow sclera. An abdominal soft mass sized in6 cm×4 cm, and was unable to push back abdominal cavity. Ultrasound showed that the echo of subcutaneous fascia was interrupted with a9 mmlong defect, and a mass about53 mm×20 mm×39 mmwith slightly strong echo was found superiorly, and bowel and omentum-like tissues seemed to connect with intra-abdominal cavity. Moreover, abdominal CT scan demonstrated that linea alba hernia. An irregular ulcer sized4 cm×3.5 cmwas found by gastroscopy, and poorly-differentiated adenocarcinoma proven by biopsy. Furthermore, laboratory examination showed that hemoglobin was73g/L, and carcinoembryonic antigen (CEA) 3.0 ug/L. A exploratory laparotomy wad performed under epidural anesthesia, a soft, yellowish, sized3 cm×4 cm×4 cmtumor was found in lineal alba, which connected with round hepatic ligament; the gastric cancer located at gastric antrum, about5 cm×4 cm, with serosal invasion and Borrmann type 3. Therefore, a radical distal gastrectomy and linea albs hernia repair were performed. The recovered smoothly and discharged healthy.