Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Ann Thorac Surg. 2012 Nov;94(5):1701-5. doi: 10.1016/j.athoracsur.2012.07.001. Epub 2012 Sep 7.
Synthetic materials have traditionally been used for tissue reconstruction in thoracic surgery. New biomaterials have been tested in other areas of surgery with good results. The aim of our study is to evaluate our initial experience using prostheses in extended thoracic surgery.
A review was performed of all patients who underwent extended surgical procedures requiring soft tissue reconstruction with bioprosthetic materials after thoracic surgery from August 2009 to August 2011. A total of 44 consecutive patients were included. Operations involved radical pleurectomy and decortication for mesothelioma (n = 29), extended operations for thoracic malignancies (n = 8), surgery for trauma or perforated organs or complications (n = 6), and for benign infectious causes (n = 1).
A total of 76 patches were used in 44 patients (median of 2; range 1 to 3 per patient). Median hospital stay was 13 (range 5 to 149) days. Three patients died during the postoperative period (6.8%); pulmonary embolism 5 days after intrapericardial pneumonectomy with chest wall reconstruction, fatal pneumonia 26 days after radical pleurectomy and decortication for mesothelioma, and bronchopleural fistula 11 days after pneumonectomy with diaphragm and atrium excision for lung cancer after initial chemoradiotherapy. No other surgical exploration or removal of patches has been required for infection.
Our initial experience of using bioprosthetic patches for soft tissue reconstruction in thoracic surgery has proven satisfactory with overall acceptable results. The infection rates are low even when a proportion of procedures were performed under contaminated environments. Biologic prosthesis should be part of the surgical options to reconstruct soft tissues in thoracic surgery.
在胸外科手术中，传统上一直使用合成材料进行组织重建。新的生物材料已在其他外科领域进行了测试，取得了良好的效果。我们研究的目的是评估我们在胸外科扩大手术中使用假体的初步经验。
回顾 2009 年 8 月至 2011 年 8 月期间，所有因胸外科手术后需要软组织重建而使用生物假体材料进行扩大手术的患者。共纳入 44 例连续患者。手术包括恶性间皮瘤的根治性胸膜切除术和剥脱术（n = 29）、胸恶性肿瘤的扩大手术（n = 8）、创伤或穿孔器官或并发症的手术（n = 6）以及良性感染性原因的手术（n = 1）。
44 例患者共使用 76 块补丁（中位数 2 块；范围 1 至 3 块/例）。中位住院时间为 13 天（范围 5 至 149 天）。3 例患者术后死亡（6.8%）；心包内肺切除术和胸壁重建后 5 天发生肺栓塞、根治性胸膜切除术和剥脱术治疗恶性间皮瘤后 26 天发生致命性肺炎、初始放化疗后肺癌切除肺切除术和横膈膜切除术及心房切除术 11 天发生支气管胸膜瘘。没有因感染而需要进行其他手术探查或移除补丁。
我们在胸外科手术中使用生物假体进行软组织重建的初步经验证明是令人满意的，总体结果可接受。即使部分手术在污染环境下进行，感染率也较低。生物假体应成为胸外科重建软组织的手术选择之一。
