Dingemann C, Linderkamp C, Weidemann J, Bataineh Z A, Ure B, Nustede R
Hannover Medical School, Department of Pediatric Surgery, Hannover, Germany.
Eur J Pediatr Surg. 2012 Feb;22(1):34-9. doi: 10.1055/s-0031-1285873. Epub 2011 Sep 29.
Primary thoracic wall malignancy is a rare and diverse entity in children. Surgical treatment commonly involves major chest wall resection causing large defects requiring complex reconstruction. In adults, the use of alloplastic and/or xenogenic materials and muscle flap repair is well established. However, literature provides only little information on procedures in children. We report our experience in 8 consecutive children who underwent chest wall resection and reconstruction with regard to surgical treatment and outcome.
Retrospective study of all children with primary malignant chest wall tumors requiring rib resection and reconstruction with prosthetic material performed in our institution between November 2002 and April 2010. Endpoints were postoperative complications and long-term results, focusing on scoliosis defined radiologically by the Cobb angle.
8 children (7 male, 1 female) with a median age of 10.6 (4.1-18.9) years underwent resection of thoracic wall tumors. A mean number of 3 (1-5) ribs were resected. Stability was obtained using rigid prosthetic material (STRATOS™ titanium bar) in 2 patients and/or non-rigid prosthetic material (Goretex® patch in 6 patients, Vicryl® patch in 3 patients, Tutopatch® in 1 patient). A muscular flap was added in 5 patients. Postoperative complications included superficial wound infection (n = 2) and dislocation of a titanium bar necessitating removal in 1 patient. No infections of the prosthetic material were observed. No perioperative mortality occurred. At a mean follow-up of 37.5 (4-97) months, 6 patients were alive. 2 patients died due to early tumor recurrence. Mild scoliosis (Cobb angle 10-20°) was detected in 2 of the surviving patients (33%).
Surgical reconstruction after resection of malignant thoracic wall tumors using non-rigid prosthetic material is safe and effective in pediatric patients, whereas rigid prosthetic material might dislocate. Scoliosis represents a long-term complication after chest wall reconstruction and should be monitored during routine follow-up.
原发性胸壁恶性肿瘤在儿童中是一种罕见且多样的疾病。手术治疗通常涉及大范围胸壁切除，会造成大的缺损，需要进行复杂的重建。在成人中，使用异体材料和/或异种材料以及肌瓣修复已得到广泛认可。然而，关于儿童手术方法的文献资料很少。我们报告了8例连续接受胸壁切除和重建手术的儿童的手术治疗情况及结果。
对2002年11月至2010年4月期间在我院接受原发性恶性胸壁肿瘤切除并使用假体材料进行肋骨重建的所有儿童进行回顾性研究。观察终点为术后并发症和长期结果，重点关注通过Cobb角进行影像学定义的脊柱侧弯。
8例儿童（7例男性，1例女性）接受了胸壁肿瘤切除，中位年龄为10.6（4.1 - 18.9）岁。平均切除3（范围1 - 5）根肋骨。2例患者使用刚性假体材料（STRATOS™钛棒）和/或非刚性假体材料（6例患者使用Goretex®补片，3例患者使用Vicryl®补片，1例患者使用Tutopatch®）获得了稳定性。5例患者加用了肌瓣。术后并发症包括表浅伤口感染（2例）以及1例钛棒移位需要取出。未观察到假体材料感染。无围手术期死亡。平均随访37.5（4 - 97）个月时，6例患者存活。2例患者因肿瘤早期复发死亡。2例存活患者（33%）检测到轻度脊柱侧弯（Cobb角10 - 20°）。
在儿科患者中，使用非刚性假体材料切除恶性胸壁肿瘤后进行手术重建是安全有效的，而刚性假体材料可能会移位。脊柱侧弯是胸壁重建后的一种长期并发症，应在常规随访中进行监测。
