Chida Masayuki, Hayama Makio, Kobayashi Satoru, Ishihama Hiromi, Oyaizu Takeshi, Minowa Muneo, Matsumura Yuji
Department of General Thoracic Surgery, Dokkyo Medical Uni versity, School of Medicine, Mibu, Tochigi, Japan.
Ann Thorac Cardiovasc Surg. 2013;19(4):268-72. doi: 10.5761/atcs.oa.11.01860. Epub 2012 Nov 17.
Lung cancer located in the paravertebral region occasionally invades the rib head (T3) and not the spine (T4). In such cases, a costotransverse ligament release (CTLR) method may be useful for complete resection without performing a vertebrectomy.
Eighteen patients with lung cancer underwent chest wall resection between 2001 and 2009 at our institutions. Of those, 7 who underwent chest wall removal with rib head resection via a CTLR method (group A) and 11 without rib head resection(conventional distal rib resection, group B) were retrospectively analyzed.
Three patients in group A underwent induction chemoradiotherapy. All rib head resections were performed via a CTLR approach without postoperative complications. There were no deaths within 30 day in group A and 1 in group B. The mean number of resected rib heads was 2.1 in group A, while 2.0 ribs were removed in group B. There was no significant difference for operation time between groups A and B(332±112 vs. 287±114 mins, p = 0.449). Local recurrence was seen in 0 patients in group A and 3 in group B(p = 0.13). The median survival time was 1489 and 727 day, respectively, while 5-year survival rates were 0.48 and 0.41, respectively.
A rib head resection via a CTLR method is an effective procedure for T3 lung cancer infiltrating the rib head.
位于椎旁区域的肺癌偶尔会侵犯肋骨头（T3）而不侵犯脊柱（T4）。在这种情况下，肋横突韧带松解术（CTLR）可能有助于在不进行椎体切除的情况下实现完整切除。
2001年至2009年期间，我们机构有18例肺癌患者接受了胸壁切除术。其中，7例通过CTLR方法进行了肋骨头切除的胸壁切除术（A组），11例未进行肋骨头切除（传统远端肋骨切除术，B组），对其进行回顾性分析。
A组3例患者接受了诱导放化疗。所有肋骨头切除均通过CTLR方法进行，术后无并发症。A组30天内无死亡病例，B组有1例死亡。A组切除肋骨头的平均数量为2.1个，而B组切除了2.0根肋骨。A组和B组的手术时间无显著差异（332±112分钟对287±114分钟，p = 0.449）。A组0例出现局部复发，B组3例（p = 0.13）。中位生存时间分别为1489天和727天，5年生存率分别为0.48和0.41。
通过CTLR方法进行肋骨头切除是治疗侵犯肋骨头的T3期肺癌的有效方法。
