基于多学科综合治疗模式的胸壁肿瘤术后巨大复合组织缺损的修复策略  

MDT-based repair strategy for giant composite tissue defects after chest wall tumor resection

作　　者：俞楠泽[1] 孙怡馨 张海林[1] 曾昂[1] 王智[1] 龙笑[1] 白明[1] 冯程 黄久佐[1] 肖一丁 孟湉 龙飞[1] 赵茹[1] 李单青[2] 王晓军[1] YU Nanze;SUN Yixin;ZHANG Hailin;ZENG Ang;WANG Zhi;LONG Xiao;BAI Ming;FENG Cheng;HUANG Jiuzuo;XIAO Yiding;MENG Tian;LONG Fei;ZHAO Ru;LI Danqing;WANG Xiaojun(Division of Plastic Surgery,Department of Surgery,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100032,China)

机构地区：[1]中国医学科学院北京协和医院整形美容外科,北京100032 [2]中国医学科学院北京协和医院胸外科,北京100032

出　　处：《中国美容整形外科杂志》2022年第11期688-692,共5页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探究胸壁肿瘤切除术后巨大复合组织缺损重建的策略。方法自2007年1月至2021年1月,中国医学科学院北京协和医院整形美容外科对基于多学科综合治疗(multi-disciplinary team,MDT)模式胸壁肿瘤术后巨大复合组织缺损修复的23例患者,进行回顾性分析和总结。结果在纳入的23例患者中,19例进行了骨性重建,其中8例钛网,11例钛棒。23例患者均接受了软组织重建,其中12例采用带蒂背阔肌肌皮瓣,4例采用带蒂腹直肌肌皮瓣,4例采用胸大肌肌皮瓣,2例采用局部皮瓣,1例采用游离股前外侧皮瓣。术后平均随访时间为(32.96±22.85)个月,11例恶性肿瘤患者因肿瘤转移死亡,另外7例恶性肿瘤患者及5例良性肿瘤患者存活。12例存活患者中,3例术后出现局部伤口愈合不良,采取扩大清创,二期局部皮瓣转移覆盖缺损区域,其余患者皮瓣完全成活。结论胸壁肿瘤切除术后巨大复合组织缺损修补需要多学科协作,根据患者情况进行个性化治疗。修复的基本思路是分层重建,骨性重建采用钛棒、钛网,软组织修复重建则应用背阔肌皮瓣、腹直肌皮瓣等。Objective To explore the strategy of reconstruction of giant composite tissue defects after chest wall tumor resection.Methods Medical records of reconstruction of giant composite tissue defects after chest wall tumor resection from January 2007 to January 2021 were retrospectively analyzed and summarized.Twenty-three patients underwent multi-disciplinary team(MDT)treatment were involved in this study.Results In all patients included,19 patients underwent bone reconstruction,of which 8 used titanium mesh and 11 used titanium rods.All patients received soft tissue reconstruction,of which 12 used pedicled latissimus dorsi musculocutaneous flap,4 used pedicled rectus abdominis musculocutaneous flap,4 used pectoralis major musculocutaneous flap,2 used local flap and 1 received free anterolateral thigh flap.The average follow-up period was(32.96±22.85)months.Finally,11 patients with malignant tumors died of metastasis,and the other 7 patients with malignant tumors and 5 patients with benign tumors survived.Among 12 surviving patients,3 experienced expanded debridement and local flap transfer because of unhealing wound.Conclusion The repair of giant composite tissue defects after chest wall tumor resection requires multidisciplinary collaboration.The basic idea of repair is bone reconstruction and soft tissue repair.For bone reconstruction,titanium rods and titanium mesh can be used.For soft tissue repair,latissimus dorsi flap and rectus abdominis flap can be used.

关 键 词：胸壁肿瘤 胸壁巨大缺损 组织重建 皮瓣 

分 类 号：R734.4[医药卫生—肿瘤]