胸壁肿瘤术后缺损的修复重建  

Postoperative chest wall reconstruction for patients with tumor

作　　者：宋达疆[1] 李赞[1] 周晓[1] 肖高明[2] 彭小伟[1] 周波[1] 吕春柳[1] 杨丽嫦[1] 彭文[1] 欧延[1] 

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]湖南省肿瘤医院胸外一科,长沙410008

出　　处：《中国临床医学》2017年第1期112-115,共4页Chinese Journal of Clinical Medicine

基　　金：湖南省自然科学基金面上项目(13JJ5012);湖南省科技计划项目(2014SK3002);湖南省卫生和计划生育委员会课题(B2014-111)~~

摘　　要：目的:探讨胸壁肿瘤术后胸壁复杂缺损的修复方法。方法:2007年3月至2014年12月共完成胸壁肿瘤缺损修复46例,平均51.7岁。其中,皮肤鳞状细胞癌16例,软组织肉瘤8例,乳腺癌复发22例。单纯肋骨缺损15例,采用单纯网片修复;单纯软组织缺损14例,采用带蒂皮瓣修复;胸壁全层缺损合并胸骨、心前区、大范围的肋骨缺损17例,采用"网片+骨水泥+网片"三明治的方法坚强内固定,软组织修复采用带蒂或游离皮瓣修复。结果:1例腹直肌带蒂皮瓣术后边缘部分坏死,再采用局部推进皮瓣修复;1例游离腹壁下动脉穿支皮瓣修复患者术后第2天出现静脉危象,急诊手术探查清除血块后皮瓣顺利成活;其余患者伤口均一期愈合,皮瓣完全成活。随访12~68个月,平均(29.4±0.7)个月,无患者复发,皮瓣外观、功能恢复满意。结论:不同形式的带蒂皮瓣和游离皮瓣是修复肿瘤切除术后复杂缺损的有效方法。Objective：To explore the postoperative chest wall reconstruction method for patients with tumor. Methods：There were 46 patients who underwent chest wall reconstruction in our Department from March 2007 to December 2014.The mean age of the patients was 51.7.Histological diagnosis including squamous-cell carcinoma （n= 16）,soft tissue sarcoma （n= 8）and metastasis from breast cancer （n= 22）.Simple rib defects occurred in 15 cases,using mesh repairments only;simple soft tissue defects were noted in 14 cases,pedicle flaps were used;in 17 cases complicated composite chest wall defects involving multiple layers （soft tissue,ribs/sternum,and intrathoracic organs）methylmethacrylate/polypropylene mesh sandwich prostheses were used.The chest wall soft tissue defects were repaired with pedicled or free flap.Results：In 1 case with pedicled rectus abdominis flap partial necrosis was noted,local flap was used for repairmen after further revision.In 1 case with free deep inferior epigastric artery perforator flap,postoperative venous congestion occurred.The re-exploration procedure was carried out and the flap survived totally.The mean follow-up was （29.4±0.7）months,with a range from 12 to 68 months.No tumor extirpation was noted,functional and appearance results were satisfying.Conclusions：Various pedicled and free flaps are efficient for large complex chest defects reconstruction.

关 键 词：胸壁缺损 皮瓣 胸壁肿瘤 

分 类 号：R628[医药卫生—整形外科]