肋骨肿物切除七例报告  

Surgical excision of rib mass in seven patients

作　　者：莫安 胜陈凯 赖晓玉 MO An-sheng;CHEN Kai;LAI Xiao-yu(Department of Cardiothoracic Surgery,Department of Pathology,Wuming Hospital of Guangxi Medical University,Nanning,Guangxi,530199,China)

机构地区：[1]广西医科大学附属武鸣医院心胸外科,南宁530199 [2]广西医科大学附属武鸣医院病理科,南宁530199

出　　处：《中国骨与关节杂志》2025年第2期146-154,共9页Chinese Journal of Bone and Joint

基　　金：2023年广西医疗卫生适宜技术开发与推广应用项目(S2023098)。

摘　　要：目的总结分享7例肋骨肿物患者手术治疗的经验。方法回顾分析2021年9月至2023年7月,7例单纯肋骨肿物患者(不包括肺癌侵犯肋骨的病例,不包括恶性肿瘤的肋骨转移)的治疗经过和效果,其中男3例,女4例。肿物分别位于左第四肋骨中前段1例、左第三肋骨中段1例、右第七肋骨前段2例、右第三肋骨前段1例、右第二和三肋骨前段及右第四肋骨前段各1例。结果7例患者手术均顺利完成,年龄12~59岁,平均(34.86±16.77)岁,其中1例软骨肉瘤的患者采用开放手术和胸壁重建,2例采用胸腔镜辅助手术,其余4例行全胸腔镜手术(其中1例采用经剑突下与经肋间联合入路)。肋骨肿物长径为27~74 mm,平均(54.20±17.15)mm,横径为10~67 mm,平均(32.06±17.71)mm,其中肿物长径和横径都≤5 cm的患者有3例。本组7例病理诊断分别为骨纤维结构不良2例(良性)、骨软骨瘤2例(良性)、非骨化性纤维瘤1例(良性)、嗜酸性肉芽肿1例(良性)、软骨肉瘤1例(恶性)。手术后例3右前胸壁有局部轻度凹陷,例4肋骨切除部位出现慢性疼痛(经过疼痛科3次局部封闭治疗后疼痛消失)。其余病例无并发症,顺利恢复,随访至今无复发病例。结论肋骨恶性病变建议行开放手术切除;肋骨良性病变的手术策略需要根据病变大小、性别、部位选择腔镜或者开放手术。Objective To summarize the experience of surgical treatment of seven patients with rib mass.Methods This study was a retrospective study,including 7 patients between January 2021 and July 2023.Among them,there were 3 males and 4 females.The masses were located in the middle anterior segment of the left fourth rib in one case,the middle segment of the left third rib in one case,the anterior segment of the right seventh rib in two cases,the anterior segment of the right third rib in one case,the anterior segment of the right second and third ribs in one case,and the anterior segment of the right fourth rib in one case.Results All the surgeries went successfully.The average age of patients was(34.86±16.77)years(range:12-59 years).Among the seven patients,one patient with chondrosarcoma underwent open surgery and chest wall reconstruction,two patients underwent thoracoscopic-assisted surgery,and the remaining four patients underwent full-thoracoscopic surgery(one of the patients was treated with a combined approach of transxiphoid and transintercostal approach).The average length of the mass was(54.20±17.15)mm(range:27-74 mm)and the average transverse diameter was(32.06±17.71)mm(range:10-67 mm)respectively.There were 3 patients with both the length and transverse diameter of the mass≤5 cm.Postoperative pathologic diagnosis indicated fibrous dysplasia in two cases(benign),osteochondroma in two cases(benign),nonossifying fibroma in one case(benign),langerhans cell histiocytosis in one case(benign)and chondrosarcoma in one case(malignancy).No complication was observed and all recovered smoothly except Case 3 with a slight depression in the right anterior chest wall,and Case 4 with chronic pain at the rib resection site(the pain disappeared after three topical analgesics).Conclusions Open surgical resection is recommended for rib malignant lesions.Lumpectomy or open surgery should be decided according to the size,sex and location of the lesion.

关 键 词：肋骨 骨肿瘤 胸腔镜 胸外科手术 电视辅助 胸壁重建 

分 类 号：R738.1[医药卫生—肿瘤]