胸部肿瘤切除联合3D打印碳纤维胸壁重建术患者的护理

目的总结胸部肿瘤切除联合3D打印碳纤维胸壁重建术患者的围术期护理经验。方法对12例行胸部肿瘤切除联合3D打印碳纤维胸壁重建术的患者,加强肺部感染预防与护理、伤口及皮瓣护理、排异反应预防等围术期护理。结果 12例患者术后均未发生排异反应;术后早期并发肺部感染1例、心律失常1例、伤口愈合不良1例,经处理后均痊愈;其余患者术区伤口均Ⅰ期愈合;胸腔引流管留置时间为(6.00±0.56) d,住院时间为(14.50±4.89)d。结论 3D打印医用复合碳纤维材料可用于胸部肿瘤切除术后的胸壁重建修复,系统的围术期护理能有效缩短平均住院时间,改善患者预后。     

胸骨上段肿瘤切除3D打印假体重建1例报告

<正>原发性恶性胸骨肿瘤并不常见,大多数是肉瘤,根治性切除是首选治疗方案。随着3D打印钛合金假体技术用于胸壁重建,胸壁扩大切除越来越广泛应用于临床。对于胸骨上段肿瘤,为了保证切缘阴性,多需要切除胸锁关节。胸锁关节缺失对上肢的功能影响如何,胸锁关节能否重建,目前相关报道不多。本院收治1例胸骨柄肉瘤患者,采用3D打印技术重建胸骨和胸锁关节,手术后取得较好的治疗效果,现报告如下。1病例资料患者,男,37岁,因“胸骨上段皮肤逐渐隆起伴持续性疼痛6个月”入院。胸骨上段压痛明显,皮肤肿胀隆起范围约4 cm×3 cm,颜色正常,双上肢上举、内旋时疼痛明显加重。全身PET-CT检查显示：在胸骨上段可见范围约3 cm×2 cm×1.5 cm肿物,     

胸骨内生软骨瘤1例

胸骨肿瘤包括原发性肿瘤和继发性肿瘤,胸骨肿瘤的治疗临床一般选择手术切除的方式.内生软骨瘤是一种软骨源性骨肿瘤,最多见于手足等短管状骨,其次位于肱骨、股骨等长骨,也有生长于盆骨等处.本文介绍1例较为罕见的胸骨内生软骨瘤患者,该患者实施了胸壁重建术.     

3D打印聚醚醚酮胸肋骨置入物在胸骨浆细胞瘤外科治疗中的初步探索性研究

目的:探索使用胸骨全切或部分切除术治疗胸骨孤立性浆细胞瘤的有效性及使用3D打印聚醚醚酮(PEEK)置入物对胸壁缺损进行重建的可行性。方法:本研究共纳入胸骨孤立性浆细胞瘤患者6例,其中男5例,女1例,年龄(57.7±9.4)岁(42～71岁),所有患者接受了胸骨全切或部分切除术治疗胸骨浆细胞瘤,并在切除后使用3D打印PE...     

胸骨软骨肉瘤胸壁钛网重建术一例

患者 男，66岁。发现胸前区肿块3年，胀痛2个月入院。既往有慢性阻塞性肺病史20余年。查体：桶状胸，胸骨有缘第3至第5肋处有一直径约10cm大小的包块突起，质硬，固定，无活动性，轻度触痛。心电图示：窦性心动过速，肺性P波，肢体低电压。胸部CT示：胸骨下份呈膨胀性骨质破坏，巨大软组织肿块影，向体表和右胸腔突出，前后径约12cm。肺功能检查：最大通气量实测值占预计值的21％，第1秒用力呼气容积实测值占预计值的18％。血气分析：动脉血二氧化碳分压43mmHg，动脉血氧分压56．3mmHg，血氧饱和度87．5％。     

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

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。     

复杂胸部肿瘤切除胸壁重建术患者的康复护理

目的总结复杂胸部肿瘤切除胸壁重建患者的围手术期营养与康复护理经验。方法对10例复杂胸部肿瘤胸壁重建患者,实施饮食指导、康复锻炼、皮瓣观察、疼痛管理等围术期护理。结果 10例患者均顺利康复出院,术后出现胸腔积液3例,皮瓣危象、上肢淋巴水肿、自发性气胸、胸壁软化、心律失常各1例,经及时处理后均好转,伤口I期愈合。术后平均住院时间14.6d。结论胸壁重建是胸壁肿瘤尤其是复杂胸壁缺损的重要手术方法,围术期康复护理能促进患者术后恢复进程,改善预后。     

胸壁肿瘤切除后胸壁大块缺损的修复重建

目的探讨胸壁肿瘤切除后胸壁大块缺损的修复重建方法。方法回顾性分析近10年来24例胸壁肿瘤切除后胸壁大块缺损患者的临床资料,24例患者均联合应用不锈钢丝和绦纶补片进行胸壁重建。结果全组无手术死亡,无胸壁软化及反常呼吸运动,无切口感染,1例术后发生伤口局部积液。全组患者术后随访1月～10年,无1例钢丝断裂及反常呼吸,胸壁凹陷畸形不明显,胸廓外形的满意率达95.8%（23/24）。结论不锈钢丝和涤纶补片是修复重建胸壁大块缺损的一种很好材料,取材方便,操作简便,胸廓稳定性良好,临床疗效确切。     

胸骨肿瘤切除同期行自体肋骨和带蒂大网膜移植胸廓重建术的护理配合

对12例胸骨肿瘤患者行胸骨肿瘤切除并应用自体肋骨和带蒂大网膜移植进行胸廓重建手术。结果12例患者手术顺利,无围术期死亡,无严重并发症,切口均一期愈合,无反常呼吸。提出做好术前访视及患者心理护理,术前充分准备手术器械、一次性手术用物、药品、仪器等,建立静脉通道并保持畅通;术中注意体位护理,密切观察患者生命体征的变化及手术进展,准确迅速传递手术器械及用物,及时更换器械及手套,做好肿瘤隔离操作,可保证手术进展顺利,提高手术治疗效果。     

3D打印导板辅助骨盆肿瘤切除重建

[目的]介绍3D打印髋臼导板辅助骨盆肿瘤切除后重建的手术技术和初步临床效果。[方法] 2017年1月—2018年10月本院18例骨盆肿瘤患者采用3D打印髋臼导板辅助骨盆肿瘤切除后重建。按术前影像明确骨盆内异常信号范围,判断肿瘤大小、侵犯程度及范围,以3D打印技术打印1∶1实物模型,进行手术模拟,确定切除与重建方案,并设计相应的导板。实际手术中,按术前方案,并在导板引导下施行肿瘤切除与骨盆重建。[结果]18例患者均顺利完成手术,且均获得随访,随访时间18～24个月。随访期间18例患者均存活,无因病死亡病例。肌肉骨骼肿瘤学会（musculoskeletal tumor society, MSTS）评分[5]由术前（12.6±2.0）分,显著增加至出院时（18.6±1.2）分,末次随访时（21.3±1.1）分,差异有统计学意义（P<0.05）。与术前比较,术后旋转中心距正中线距离、臼前倾角和外展角的患侧与健侧差值均减小,差异有统计学意义（P<0.05）。随访期间均未出现内固定松动或断裂,局部无复发。[结论]骨盆肿瘤切除及重建中应用3D打印髋臼导板具有手术时间短、术后恢复快、预后好...     

1例胸部肉瘤切除穿支皮瓣重建胸壁患者的护理

对1例胸部肉瘤实施肉瘤切除的同时行穿支皮瓣重建胸壁。2周后皮瓣完全成活,患者未发生任何并发症,痊愈出院。提出关注患者的心理及情绪,做好周密、细致的术前准备,术后严密监测皮瓣血液循环,加强营养支持,系统的康复指导是其护理重点。     

钛板联合Teflon补片重建胸骨肿瘤切除后胸廓

目的探讨胸骨肿瘤切除术后采用钛板联合Teflon补片重建胸廓的方法及疗效。方法 2006年10月-2009年11月,收治4例胸骨肿瘤患者。男2例,女2例;年龄30～55岁。以胸部肿块、疼痛1～6个月后入院。检查见胸前区范围为4 cm×3 cm～10 cm×8 cm的肿块,质硬。CT检查见骨质破坏。采用胸骨肿瘤扩大切除术,切除范围为10 cm×8 cm～18 cm×14 cm,采用钛板联合Teflon补片重建胸廓。结果患者手术均顺利完成。术后切口Ⅰ期愈合,未出现反常呼吸、皮下气肿、气胸、感染等并发症。术后6个月1例失访,1例术后25个月因颅内出血死亡;余2例分别获随访1年及4年,肿瘤未见复发。所有患者胸壁塑形良好,随访期间钛板无松动、外露,无呼吸困难、胸闷、胸痛等不适。结论胸骨肿瘤切除后采用钛板联合Teflon补片重建胸廓,具有手术操作简便、塑形效果满意、术后并发症少等优点。     

3D打印技术用于复杂Pilon骨折患者的护理

目的探讨3D打印技术用于复杂Pilon骨折患者的护理方法。方法将3D打印技术应用于91例复杂Pilon骨折治疗。术前利用3D打印模型对患者实施健康教育,做好跟骨牵引及运动指导;术后提供患肢护理,预防皮肤坏死感染、腓总神经压迫等并发症护理。结果患者骨折均完全愈合,愈合时间12~18周,平均14.7周;完全负重时间12~16周,平均13.8周。结论将3D打印技术应用于Pilon骨折患者治疗,能提供直观、形象的实物模型,有助于医护人员开展围术期准备及护理,提高手术效果及患者配合程度。     

Novel titanium constructs for chest wall reconstruction in children

Purpose

We have previously reported the use of the vertical expandable prosthetic titanium rib (VEPTR) for treatment of thoracic dystrophy. This report describes our experience with this device and other novel titanium constructs for chest wall reconstruction.

Methods

This is a retrospective chart review of all children and adolescents undergoing chest wall reconstruction with titanium constructs between December 2005 and May 2010.

Results

Six patients have undergone chest wall reconstruction with VEPTR or other titanium constructs. Four had chest wall resection for primary malignancy, 1 had metastatic chest wall tumor resection, and 1 had congenital chest wall deformity. There were no immediate complications, and all patients have exhibited excellent respiratory function with no scoliosis.

Conclusions

Chest wall reconstruction after tumor resection or for primary chest wall deformities can be effectively accomplished with VEPTR and other customized titanium constructs. Goals should be durable protection of intrathoracic organs and preservation of thoracic volume and function throughout growth. Careful preoperative evaluation and patient-specific planning are important aspects of successful reconstruction.     

心血管手术后并发胸骨哆开患者的护理

目的总结心血管手术后胸骨哆开患者的护理经验。方法 2 980例患者心血管术后并发胸骨哆开13例,对其行急诊手术后实施精心护理。结果 12例痊愈出院,1例因多器官衰竭于术后5d死亡。结论胸骨哆开是心血管手术后少见但后果严重的并发症,及早诊断,积极手术治疗,术后做好呼吸道护理、引流管护理、加强营养支持、积极预防感染可取得良好的治疗效果。     

Primitive chest wall neuroectodermal tumor in a pediatric patient

A 13-year-old boy with a primitive neuroectodermal tumor of the chest wall is presented. After four cycles of chemotherapy, a computed tomography scan of his chest showed a larger mass invading the left upper lobe of the lung. He underwent resection of the left chest wall from the left fourth to sixth ribs, including the tumor, combined with left upper lobectomy and lymph node dissection. A diagnosis of primitive neuroectodermal tumor was confirmed histopathologically and immunohistochemically. After surgery, four cycles of chemotherapy with ifosfamide and etoposide were given. One year after treatment, the patient is currently doing well without evidence of recurrence.     

Resection of a metastatic sternal carcinoma and reconstruction of the chest wall: a case report

A large metastatic squamous carcinoma of the anterior chest wall was managed by en-bloc resection of the thoracic wall. The extensive defect resulting from the resection was bridged with Marlex mesh superimposed on an omental flap that served as recipient to partial-thickness skin grafts. This composite reconstruction restored an efficient bellows action to the chest cage, manifested by the lack of anterior flailing and postoperative spirometry values, measured at the bedside, that were 75% of those obtained preoperatively. During the initial postoperative period, however, mechanical ventilatory assistance was required to treat an adult respiratory distress syndrome that together with mild anterior flailing made early extubation impossible.     

Anterior chest wall reconstruction with titanium plate sandwiched between two polypropylene sheets

Extensive sternal resection carries the risk of difficult reconstruction and surgical complications. A 79-year-old woman underwent sternal resection and reconstruction for sternal chondrosarcoma. However, 18?months after the first operation, she developed six metastatic tumors on the anterior chest wall. She underwent subtotal sternectomy and rib resection, leaving a defect measuring 17?×?14?cm. Reconstruction of the anterior chest wall using a titanium plate sandwiched between two polypropylene mesh sheets is described. This method is potentially applicable to extensive anterior chest resection, and its advantages compared with conventional prostheses are rigidity, flexibility, and usability.     

Single stage sternal reconstruction using titanium mesh for dehiscence following open-heart surgery

Wound complications are a well-recognised entity following median sternotomy. Soft tissue reconstruction in the form of muscle flaps generally provides adequate wound stability; nevertheless, skeletal reconstruction of the anterior chest wall is sometimes necessary. We describe a novel technique applied in three patients for reconstructing fragments of the sternum using a titanium mesh that provides a scaffold for the bony union.