累及胸壁的胸部肿瘤的外科治疗——胸壁切除与重建(附12例报告)  

Chest Wall Resection and Reconstruction for Thoracic Tumor Invading the Chest Wall:A Report of 12 Cases

作　　者：马少华[1] 申潞艳[1] 李森恺 师晓天 梁震[1] 陈克能[1] 

机构地区：[1]北京大学肿瘤医院暨恶性肿瘤发病机制及转化研究教育部重点实验室胸外一科,北京100142 [2]中国医学科学院整形外科医院,北京100144 [3]安阳肿瘤医院胸外科,安阳455001

出　　处：《中国肺癌杂志》2012年第2期90-96,共7页Chinese Journal of Lung Cancer

基　　金：北京市卫生系统高层次卫生技术人才培养计划(No.2009-2-17);北京市自然科学基金项目(No.7102029);首都医学发展科研基金(No.2007-1023);教育部博士生学术新人奖;国家973计划(No.2011CB504-300)资助~~

摘　　要：背景与目的胸部肿瘤累及胸壁是临床常见事件,若无远处转移,完整切除受累胸壁仍可获得良好疗效。本文结合12例肿瘤患者胸壁切除与重建(chest wall resection and reconstruction,CWRR)的经验就重建人工材料、软组织覆盖等方面作一介绍,并强调切除外科与重建外科合作的重要性。方法总结2005年10月-2011年4月北京大学肿瘤医院胸外一科和重建外科共同参与的CWRR 12例,详细复习自确诊至今的诊治全过程,包括术前治疗、手术方式、切除范围、重建方式,主要的局部及全身并发症及生存情况。结果 12例均为根治性手术,均行骨性胸壁切除,切除后骨性胸壁缺损为25 cm^2-700 cm^2,胸壁软组织缺损为56 cm^2-400 cm^2。骨性胸壁修补材料采用聚丙烯单丝网片(polypropylene mesh),软组织修复采用转移肌瓣、转移肌皮瓣及大网膜瓣。术后1例发生呼吸衰竭,呼吸机辅助通气1个月后痊愈,余例均无并发症,全组12例至今全部存活。结论只有切除外科和重建外科同时参与才能完成符合肿瘤原则的复杂CWRR。由切除外科主导、重建外科协助、了解并熟悉重建材料及胸壁软组织重建,是达到手术根治性及保证远期生存的关键。Background and objective Tumor involving the chest wall is a common clinical event,and if there are no distant metastases,complete resection of tumor and involved chest wall can give excellent results.The aim of this study is to report experience with chest wall resection and reconstruction（CWRR） for 12 patients who suffered thoracic malignant tumor involving chest wall,including the artificial materials used for reconstruction,soft tissue coverage,and our multidisciplinary CWRR approach.Methods All characteristics of 12 cases of CWRR from Oct 2005 to Apr 2011 were reviewed,including preoperative treatment,surgical approach,resection range,reconstruction methods,the local and systematic complications and postoperative survival.Results All 12 of these patients underwent radical resection and hony chest wall resection,with resultant hony chest wall defects ranging from 25 cm to 700 cm,soft tissue defects of 56 cm to 400 cm.The hony chest wall was reconstructed using polypropylene mesh,and repair of the soft tissue was carried out using the shifting muscle flaps,myocutaneous flaps and omental flaps.There was only one significant complication in these 12 cases where 1 case suffered respiratory failure and needed mechanical ventilation hut recovered one month later.All 12 patients have survived to the end point of follow up.Conclusion Only thoracic surgery and reconstructive surgery work together can complete the complex CWRR which according the tumor discipline.Thoracic surgeons as the leader and reconstructive surgeons as the subsidiary and be familiar with reconstruction materials of bony chest wall and appropriate choice of soft tissue coverage is the key to achieve radical surgery and to ensure long-term survival.

关 键 词：胸部肿瘤 胸壁 切除 整形 

分 类 号：R734.4[医药卫生—肿瘤]