巨大原发性胸壁肿瘤的外科治疗

目的总结巨大原发性胸壁肿瘤的治疗经验。方法 23例巨大原发性胸壁肿瘤患者,根据病变部位选择不同的手术切口;有包膜者行瘤体包膜下分离,无包膜处及纵隔、胸壁浸润处则应在相应层次用锐性加钝性法进行分离,直至完整切除肿瘤。必要时切除被累及的心包、肺等组织,尽量保留未累及的胸壁软组织。胸壁缺损的修复材料包括大腿阔筋膜、Dacron补片与网格状钛合金钢板。结果切除瘤体最大直径（15.43±4.83）cm（10~26 cm）;恶性肿瘤18例,良性肿瘤5例,均被完整切除,其中12例行胸壁修复。无一例出现并发症。平均住院时间（9.91±2.56）d。结论术前正确评估肺功能、了解肿瘤与周围组织器官的关系,选择恰当的手术径路、准确的解剖层次及适宜的修复材料是手术成功的关键。

Surgical treatment for giant primary chest wall tumors

Objective To summarize the experience in the treatment of giant primary chest wall tumors. Methods Twenty-three patients with giant primary chest wall tumors undergoing surgical treatment were selected, and different operative incisions were determined according to lesion locations. Subcapsular tumors were isolated under the envelope, while tumors without envelope or tumors extending into mediastinum and chest wall were separated by sharp and blunt dissection according to anatomical structures before complete excision. Involved tissues such as pericardium and lung were cut off, while the unaffected soft tissues of chest wall were reserved as much as possible. The materials for chest wall repair included thigh fascia lata, Dacron patch and mesh-like titanium alloy plate. Results The resected tumors ranged between 10 cm to 26 cm in diameter, with an average of (15.43±4.83) cm. There were 18 cases of malignant tumors and 5 cases of benign tumors, and all were treated by complete tumor excision, with chest wall repair performed in 12 cases. No postoperative complications occurred. The mean length of hospital stay was (9.91±2.56) d. Conclusion Good knowledge of pulmonary function and relationship between tumors and adjacent organs before operation, optimal surgical approach, and proper materials for repair are the keys to successful surgical treatment for giant primary chest wall tumors.