应用钛板、钛网行胸骨柄肿瘤切除胸壁重建术13例临床分析  

Reconstruction of anterior chest wall with titanium plate and mesh:a report of 13 cases with manubrium tumor resection

作　　者：刘家祺 冯自豪 陆南杭 葛棣 卢春来 古杰 孙奉昊 丁玉芹[3] 王青乐[3] 亓发芝 Liu Jiaqi;Feng Zihao;Lu Nanhang;Ge Di;Lu Chunlai;Gu Jie;Sun Fenghao;Ding Yuqin;Wang Qingle;Qi Fazhi(Department of Plastic and Reconstructive Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Thoracic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院整形外科,上海200032 [2]复旦大学附属中山医院胸外科,上海200032 [3]复旦大学附属中山医院影像科,上海200032

出　　处：《中华整形外科杂志》2020年第3期257-262,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨胸骨柄肿瘤切除术后,应用钛板、钛网行胸壁重建术的临床效果及患者的生活质量。方法回顾性分析13例2012年1月至2016年12月期间中山医院收治的原发性、继发性胸骨柄肿瘤病例,其中男8例,女5例,中位年龄56岁(41~72岁),原发性胸骨柄肿瘤11例,纵膈肿瘤侵犯胸骨柄1例,乳腺癌转移至胸骨柄1例。行外科手术切除肿瘤后即刻应用钛板、钛网行胸壁重建修复。以欧洲五维健康量表(EQ-5D)和EQ-5D直观模拟评分量表(ED-VAS)评估患者术前、术后3个月时的生活质量,并于术后3个月拍摄CT。以Wilcoxon秩和检验进行数据分析。结果所有患者手术均顺利完成,12例围手术期无严重并发症、无死亡,切口一期愈合,术后恢复好;1例术后出现反常呼吸,予呼吸机支持,术后9 d反常呼吸消失。13例患者术后3个月的CT显示钛板、钛网无移位,无变形。均无明显上肢功能障碍。中位随访时间为25个月(7~41个月),1例软骨肉瘤患者因复发于术后11个月死亡。EQ-5D评分中疼痛或不适一项,术前为(1.85±0.80)分,术后为(1.15±0.38)分,差异具有统计学意义(P=0.013)。其余4个维度手术前、后得分差异无统计学意义(P>0.05)。术前EQ-5D问卷总分为(7.08±2.02)分,术后为(5.45±0.52)分,差异具有统计学意义(P=0.010)。术前ED-VAS得分(85.69±7.58)分,术后为(92.54±2.53)分,差异具有统计学意义(P=0.008)。结论钛板、钛网应用于胸骨柄肿瘤切除即刻胸壁重建,是安全有效的方法,可提高患者生活质量。Objective To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods A retrospective analysis was performed from January 2012 to December 2016,a total of 13 patients with primary(11cases)or secondary(2 cases)manubrium tumor,aged 41-72 years(medium aged as 56),underwent oncological resection,following by immediate chest wall reconstruction with titanium plate and titanium mesh.The quality of life was evaluated by EuroQol five dimensions questionnaire(EQ-5D)and EQ-5D visual analogue scale(ED-VAS)before and 3 months after operation.Computed tomographic scan was taken 3 months after operation.Results All the patients received successful operation.During the perioperative period,12 cases recovered well without any complications,1 patient experienced mild paradoxical movement within 9 days after operation and then recovered.The median follow-up period after surgery was 25 months(range from 7 to 41).Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation.One patient with chondrosarcoma died as a result of relapse 11 months after surgery.In pain/discomfort dimension,the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38,showing a significant difference(P=0.013).There was no significant difference in scores of other four dimensions between pre-and post-operation(P>0.05).The total score of EQ-5D decreased significantly after the operation(7.08±2.02 vs 5.45±0.52,P=0.010).The pre-and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53,with a significant difference(P=0.008).Conclusions The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

关 键 词：内固定 胸骨柄 胸壁重建 生活质量 

分 类 号：R73[医药卫生—肿瘤]