胸壁肿瘤切除后胸壁缺损的修复  

Surgical Repair and Reconstruction of Chest Wall Defect after Resection of Chest Wall Tumors

作　　者：王少强 陈静 魏松洋 郑庆杰 WANG Shaoqiang;CHEN Jing;WEI Songyang;ZHENG Qingjie(Department of Cardiothoracic Surgery,988th Hospital of PLA,Kaifeng 475003,China.;Department of Plastic Surgery,988th Hospital of PLA,Kaifeng 475003,China.)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院心胸外科,河南省开封市475003 [2]中国人民解放军联勤保障部队第九八八医院整形外科,河南省开封市475003

出　　处：《组织工程与重建外科杂志》2019年第4期237-240,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的探讨胸壁肿瘤切除后胸壁缺损的修复方法.方法2011年5月至2018年5月共收治胸壁肿瘤患者31例,其中原发胸壁良性肿瘤6例,原发胸壁恶性肿瘤14例,转移性胸壁恶性肿瘤11例.胸壁缺损类型包括单纯骨性缺损16例,单纯软组织缺损4例,全层缺损11例.骨性胸壁缺损采用补片(7例)、Prolene网片(3例)、网格状钛合金钢板(17例)进行重建.胸壁软组织缺损采用直接对拢缝合(11例)、皮瓣修复(20例).结果本组患者均顺利完成手术,术后呼吸功能良好,无反常呼吸运动.2例带蒂背阔肌肌皮瓣边缘部分坏死,1例带蒂腹直肌肌皮瓣远端部分坏死,1例游离腹壁下动脉穿支皮瓣边缘部分坏死,经换药后伤口均愈合.结论外科手术是胸壁肿瘤治疗的主要方法,术后的胸壁缺损按照大小、位置和复杂程度选择合适的材料进行修复,重建胸壁结构的稳定性及密闭性,是手术成功的关键.Objective To explore the methods of repair and reconstruction of chest wall defect after resection of chest wall tumors. Methods From May 2011 to May 2018, 31 patients with chest wall tumors were treated in our department, including 6 cases of primary benign tumors of chest wall, 14 cases of primary malignant tumors of chest wall and 11 cases of metastatic malignant tumors of chest wall. There were 16 cases of simple bone defect of chest wall, 4 cases of simple soft tissue defect of chest wall and 11 cases of full-thickness defect of chest wall. Patch (4 cases), Prolene mesh (3 cases) and mesh titanium alloy plate (17 cases) were used to reconstruct the sternal bone defect. The defect of soft tissue of chest wall were reconstructed by direct suture (11 cases) and different kinds of skin flap (20 cases). Results All the 31 patients completed the operation successfully. The postoperative respiratory functions were normal. No paradoxical respiration occurred in this group. There were 2 cases of marginal necrosis of pedicled latissimus dorsi myocutaneous flaps, 1 case of distal necrosis of pedicled rectus abdominis myocutaneous flaps and 1 case of marginal necrosis of perforator flaps of free inferior epigastric artery. The wounds healed after dressing therapy. Conclusion Surgery is the main treatment for chest wall tumors. To ensure the extent of resection and to select appropriate materials and tissue flaps for the reconstruction of chest wall according to the size, location and complexity of the defect area are the keys to the success of the operation.

关 键 词：胸壁肿瘤 胸壁缺损 胸壁重建 合成材料 游离皮瓣移植 

分 类 号：R628[医药卫生—整形外科]