Galbis Caravajal José M, Sales Badía Gabriel, Fuster Diana Carlos A, Mallent Añón José, Pallardó Calatayud Yolanda, Rodríguez Paniagua José M
Servicio de Cirugía Torácica, Hospital de La Ribera, Alzira, 46018 Valencia, Spain.
Clin Transl Oncol. 2005 Sep;7(8):351-5. doi: 10.1007/BF02716551.
Surgical treatment of tumours of the chest wall (primary or metastatic) requires special skills by the thoracic and the plastic surgeons, from the functional as well as the aesthetic perspective (oncoplastic surgery), when the treatment requires surgical reconstruction.
We present a series of 14 patients who needed extensive resection of the thoracic wall (external and/or 3 or more ribs) with disease-free margins and reconstruction with prostheses (7 with polytetrafluoroethylene [PTFE(R)] and 7 with the Sandwich Marlex-Methyl Metacrylate) technique with additional covering with muscle-skin flaps (6 pectoral, 5 recto-anterior, 3 dorsal) pedicled during the same surgical intervention.
The aetiology of the extirpated tumours, following pathology assessment, were: 4 chondrosarcoma, 3 metastatic sternum, 2 breast cancer relapse, 1 desmoid tumour, 1 neurofibrosarcoma, 1 rhabdomiosarcoma, 1 malignant schwannoma and 1 radiation induced sarcoma. One patient died from complications and another 4 from disease progression before the conclusion of the study follow-up (3-22 months).
Extensive resection of tumours of the chest wall with reconstruction using prostheses and muscle-skin flaps is a safe method that can be performed in the same surgical intervention period when combining the skills of the thoracic surgeon with that of the plastic surgeon.
胸壁肿瘤(原发性或转移性)的外科治疗,从功能和美学角度(肿瘤整形手术)来看,当治疗需要手术重建时,需要胸外科医生和整形外科医生具备特殊技能。
我们报告了一系列14例患者,他们需要对胸壁进行广泛切除(切除胸壁外层和/或三根及以上肋骨),切缘无肿瘤组织,并使用假体进行重建(7例使用聚四氟乙烯[PTFE(R)],7例使用三明治Marlex-甲基丙烯酸甲酯技术),并在同一次手术中采用带蒂肌皮瓣(6例胸大肌、5例腹直肌、3例背阔肌)进行额外覆盖。
经病理评估,切除肿瘤的病因如下:4例软骨肉瘤、3例胸骨转移瘤、2例乳腺癌复发、1例硬纤维瘤、1例神经纤维肉瘤、1例横纹肌肉瘤、1例恶性神经鞘瘤和1例放射性肉瘤。在研究随访(3 - 22个月)结束前,1例患者死于并发症,另外4例死于疾病进展。
使用假体和肌皮瓣对胸壁肿瘤进行广泛切除并重建,是一种安全的方法,在结合胸外科医生和整形外科医生技能的情况下,可在同一次手术期间进行。