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使用钛网进行巨大胸壁肿瘤切除与重建

Huge Chest Wall Tumour Resection and Reconstruction using Titanium Mesh.

作者信息

Adli Azam Mohammad Razi, Raja Amin Raja Mokhtar

机构信息

Cardiovascular and Thoracic Surgery Unit, Surgical Science Cluster, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.

Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

出版信息

Malays J Med Sci. 2015 Jan-Feb;22(1):70-3.

Abstract

Malignant chest wall tumour is rare. The presentation is usually aggressive that requires extensive resection to prevent recurrence. However, the extensive resection is to the expense of causing defect on the chest wall and hence, respiratory mechanics. Two cases of chest wall tumour are discussed including the surgical approach of radical tumour resection which was combined with placement of titanium mesh and Tranverse Rectus Abdominis Myocutaneus (TRAM) flap to cover the defect and preserve respiratory mechanical functions. The morbidity of using titanium mesh demonstrated in the case series were infection and injury to surrounding tissue due to its rigidity and large size which required its removal. However the formation of 'pseudopleura' made the thoracic cage return back as closed cavity even after the removal of the titanium mesh and allow normal respiratory functions.

摘要

恶性胸壁肿瘤较为罕见。其临床表现通常较为侵袭性,需要进行广泛切除以防止复发。然而,广泛切除是以胸壁出现缺损以及呼吸力学受影响为代价的。本文讨论了两例胸壁肿瘤病例,包括根治性肿瘤切除的手术方法,该方法结合了钛网植入和腹直肌横形肌皮瓣(TRAM瓣)来覆盖缺损并保留呼吸力学功能。病例系列中使用钛网的并发症包括感染以及因其刚性和大尺寸导致的周围组织损伤,这需要将其取出。然而,“假胸膜”的形成使胸廓即使在钛网取出后仍能恢复为封闭腔,并允许正常呼吸功能。

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本文引用的文献

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Malignant primary chest-wall tumours: techniques of reconstruction and survival.原发性恶性胸壁肿瘤:重建技术与生存。
Eur J Cardiothorac Surg. 2010 Jul;38(1):39-45. doi: 10.1016/j.ejcts.2009.12.046. Epub 2010 Feb 24.
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Chest wall reconstruction following resection of large primary malignant tumors.大型原发性恶性肿瘤切除术后胸壁重建。
Eur J Cardiothorac Surg. 1994;8(7):351-6; discussion 357. doi: 10.1016/1010-7940(94)90028-0.
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Current management of chest-wall tumors.
Surg Clin North Am. 1989 Oct;69(5):1061-80. doi: 10.1016/s0039-6109(16)44938-8.

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