Orthopaedic Department, Sir Charles Gairdner Hospital, Perth, Western Australia.
Orthop Traumatol Surg Res. 2011 Feb;97(1):73-8. doi: 10.1016/j.otsr.2010.09.014. Epub 2010 Dec 14.
Thoracic sarcomas are rare, and resection can leave behind defects that require significant reconstruction by the multidisciplinary surgical team. The aim of this study is to review the experience of our regional referral centre with primary thoracic tumor resection and thoracic reconstruction.
We have reviewed the treatment of all chest wall tumors resected at Sir Charles Gairdner Hospital in Western Australia over a 5-year period. There were 11 cases in total that involved removal of deep muscle, ribs and/or sternum.
In the six cases that required bony resection, the surgical team utilized a Gore-Tex (e-PTFE) mesh prosthesis to allow immediate closure of the defect, whilst five other closures were achievable using primary layered closure alone. Four patients had postoperative complications, including one who required prosthesis removal. Mean length of hospital stay was 5 days. No 30-day or 6-month mortality was recorded. All patients were followed-up for a minimum of 24 months, and all patients were alive and free of disease at their most recent follow-up.
This study concurs with previous literature indicating that thoracic tumor resection and immediate reconstruction often involving use of prosthetic mesh is a safe and effective one stage surgical procedure for a variety of chest wall defects with low postoperative morbidity.
胸壁肉瘤较为罕见,切除后会留下缺损,需要多学科手术团队进行重大重建。本研究旨在回顾我们区域转诊中心在原发性胸壁肿瘤切除和胸壁重建方面的经验。
我们回顾了过去 5 年在西澳大利亚州查尔斯·盖尔德纳爵士医院切除的所有胸壁肿瘤的治疗情况。共有 11 例病例涉及深部肌肉、肋骨和/或胸骨的切除。
在需要骨切除的 6 例病例中,手术团队使用 Gore-Tex(e-PTFE)网片假体来实现缺损的即刻闭合,而另外 5 例则可通过单纯的一期分层闭合来实现。4 例患者发生术后并发症,其中 1 例需要取出假体。平均住院时间为 5 天。无 30 天或 6 个月死亡率记录。所有患者的随访时间均至少为 24 个月,在最近一次随访时,所有患者均存活且无疾病。
本研究与之前的文献一致,表明胸壁肿瘤切除和即刻重建(通常涉及使用假体网片)是一种安全有效的一期手术方法,适用于多种胸壁缺损,术后发病率低。