胸壁肿瘤切除与重建方法探讨

目的探讨胸壁肿瘤切除及胸壁缺损修补重建的方法。方法回顾性分析7例胸壁肿瘤患者的临床资料,其中肋骨分化型软骨肉瘤、肋骨分化型骨肉瘤、肋骨骨巨细胞瘤及肋骨骨旁骨肉瘤各1例,肺癌胸壁转移癌2例,乳腺癌复发胸壁转移1例。行扩大根治切除4例,姑息性切除2例,限制性切除1例。切除肋骨1-3根,胸壁骨性缺损面积（4 cm×15 cm）-（15 cm×15 cm）。胸壁缺损重建6例：用部分膈肌修补加固下胸壁缺损1例,应用钢丝支架并腹壁转移肌皮瓣修补缺损1例,应用M arlex网片修补骨性缺损并同时覆盖周围肌肉瓣4例。1例限制性切除患者仅行拉拢缝合,未行胸壁重建。结果应用双层M arlex网片修补骨性缺损并同时覆盖周围肌肉瓣的3例术后胸壁稳定性满意,限制性切除的1例胸壁外观正常,余3例均出现反常呼吸。术后随访6例,时间5月-6年,4例原发性肋骨肿瘤患者均健在,3例转移癌患者死亡1例,失访1例,健在1例。结论依据胸壁缺损的位置和大小,应用双层聚丙烯网片结合自体肌肉瓣覆盖是修补重建胸壁的可靠方法 。

Exploration on the Reliable Reconstruction Methods after Chest Wall Tumor Resection

Objective To investigate the reliable reconstruction methods after chest wall tumor resection.Methods 7 cases underwent chest tumor resection were analyzed retrospectively.The indications of resection were primary chest wall tumor in 4 patients,which included 1 of rib differentiated type chondrosarcoma,1 of rib differentiated type osteosarcoma,1 of rib parosteal osteosarcoma and 1 of giant cell tumor of bone,metastatic chest wall neoplasm originated from lung cancer in 2 patients,and local recurrence from breast tumor in 1 patient.Extended radical resection was performed in 4 patients,palliative resection in 2 patients and limited resection in 1 patient.The number of rib resection for each patient ranged from 1 to 3,the size of chest wall defect after resection ranged from 4 cm×15 cm to 15 cm×15 cm.Except 1 case of limited resection performed suturation directly,the other 6 cases were reconstructed chest wall defect after tumor resection.The reconstructive methods were as follows： fixing diaphragmatic muscle of the edge of rib to repair the lower lateral chest wall defect in 1 case,using stainless steel wire to support a musculocutaneous flap in 1 case,and recently repairing bone defect with uni-or bilayer polypropylene mesh（Marlex mesh） and muscle flap in 4 cases.Results 3 cases repaired by bilayer Marlex mesh were achieved a satisfied stability of the chest wall without visible paradoxical movement.1 case with limited resection revealed normal appearance of chest wall.And the other 3 cases were found paradoxical movement.6 cases were followed up for 5 months to 6 years.4 cases of primary rib tumor and 1 case of metastatic cancer were survival,1 metastatic cancer case died,and 1 lost follow-up.Conclusion It is a reliable method to reconstruct chest wall defect with bilayer Marlex mesh and muscle flap after tumor resection.