Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France.
Eur J Cardiothorac Surg. 2012 Dec;42(6):965-70. doi: 10.1093/ejcts/ezs211. Epub 2012 May 2.
The postoperative course following sternectomy for cancer carries significant morbidity due to paradoxical breathing, pulmonary infections and infectious complications. The purpose of this report is to evaluate the outcomes in patients undergoing sternal reconstruction using an innovative titanium rib bridge system (STRATOS).
From 2008 to 2011, 24 patients underwent sternectomy with a titanium rib bridge system reconstruction. Soft coverage tissue was performed concurrently using a prosthetic mesh and pedicled or free flaps. Postoperative data were collected prospectively.
The median age was 56 (31-85 years). The indications for sternal resection were primary sarcoma (n = 4), metastasis (n = 15) and radiation-induced sarcoma (n = 5). Twenty-one subtotal and three total sternectomies were performed. Resection margins included the anterior rib (n = 13, mean: 2/patient), clavicles (n = 9), breast (n = 4), superior vena cava (n = 1), pericardium (n = 5), phrenic nerve (n = 4), lung (n = 6) and diaphragm (n = 1). The stability of the chest wall typically required an average of two titanium bars and rib clips per patient. There was no perioperative mortality. Twenty-three patients were extubated within the first 24 h. The mean intensive care unit and hospital stay was 3.5 and 14 days, respectively. Wound infection did occur in one patient but did not require the removal of the titanium rib system. The postoperative forced expiratory volume in 1 s did not differ significantly from the preoperative status (P = 0.07).
After sternectomy for cancer, reconstruction with a titanium rib bridge system has low morbidity and permits a rapid return to baseline pulmonary mechanics.
由于反常呼吸、肺部感染和感染性并发症，癌症胸骨切除术后的病程存在显著的发病率。本报告的目的是评估使用创新钛肋骨桥系统（STRATOS）进行胸骨重建的患者的结果。
2008 年至 2011 年，24 例患者接受了胸骨切除术和钛肋骨桥系统重建。同时使用假体网片和带蒂或游离皮瓣进行软组织覆盖。前瞻性收集术后数据。
中位年龄为 56（31-85 岁）。胸骨切除术的指征为原发性肉瘤（n=4）、转移（n=15）和放射诱导肉瘤（n=5）。21 例次全胸骨切除术和 3 例全胸骨切除术。切除边缘包括前肋骨（n=13，平均：每例 2 个）、锁骨（n=9）、乳房（n=4）、上腔静脉（n=1）、心包（n=5）、膈神经（n=4）、肺（n=6）和横膈膜（n=1）。胸壁的稳定性通常需要每个患者平均使用两根钛棒和肋骨夹。无围手术期死亡。23 例患者在 24 小时内拔管。平均重症监护病房和住院时间分别为 3.5 天和 14 天。1 例患者发生伤口感染，但无需取出钛肋骨系统。术后 1 秒用力呼气量与术前状态无显著差异（P=0.07）。
癌症胸骨切除术后，使用钛肋骨桥系统重建的发病率较低，并且可以快速恢复到基线肺力学。
