Campo-Cañaveral de la Cruz Jose Luis, Herrero Collantes Jorge, Sánchez Lorente David, Torres Lanzas Juan
Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
Arch Bronconeumol. 2011;47 Suppl 3:15-24. doi: 10.1016/S0300-2896(11)70024-2.
Despite the numerous differences among the distinct diseases of the chest wall, the surgery of this area shows certain common features. Treatment has progressively changed in the last few years due to advances in diagnostic techniques, minimally invasive procedures and reconstruction materials, and especially due to the multidisciplinary management of many diseases. Nuss' minimally invasive correction of pectus excavatum has gained devotees, although open approaches are performed with increasingly small incisions, almost comparable to the lateral incisions in Nuss' technique. Surgeons supporting the open approach also cite the evident disadvantages of the need for a steel implant for 2 or 3 years and for a second intervention to remove this implant. En-bloc resections with reconstruction using materials, which are increasingly better and covered by myocutaneous grafts in collaboration with plastic surgery departments, constitute a major advance in the treatment of chest wall tumors. Trimodal therapy for Pancoast tumors, consisting of induction chemotherapy and radiotherapy and subsequent surgical treatment of the tumor, currently provides the best results in terms of resectability and survival.
尽管胸壁的不同疾病之间存在诸多差异，但该区域的手术仍呈现出某些共同特征。在过去几年中，由于诊断技术、微创手术和重建材料的进步，特别是由于许多疾病的多学科管理，治疗方法已逐渐发生变化。尽管开放式手术的切口越来越小，几乎与努斯技术中的侧切口相当，但努斯微创矫正漏斗胸仍受到一些人的青睐。支持开放式手术的外科医生也指出了明显的缺点，即需要使用钢植入物2至3年，并且需要进行第二次手术取出该植入物。使用越来越好的材料进行整块切除并重建，再与整形外科合作采用肌皮瓣覆盖，这是胸壁肿瘤治疗的一项重大进展。对于肺上沟瘤的三联疗法，包括诱导化疗、放疗以及随后的肿瘤手术治疗，目前在可切除性和生存率方面提供了最佳结果。
