Chapelier A, Macchiarini P, Rietjens M, Lenot B, Margulis A, Petit J Y, Dartevelle P
Department of Thoracic & Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue (Paris-Sud University), Le Plessis Robinson, France.
Eur J Cardiothorac Surg. 1994;8(7):351-6; discussion 357. doi: 10.1016/1010-7940(94)90028-0.
Reconstructive procedures following radical resection of large primary malignant chest wall tumors (PMCWT) continue to evolve. Between 1982 and 1993, 32 consecutive patients (18 males/14 females) with a median age of 47 years (range, 12-77) underwent radical resection for large (median 10 +/- 5.4 cm) PMCWTs arising either from the bone (n = 15) or soft tissues (n = 17) of the chest wall. Nine (28%) had previous surgical resection before referral. Sixteen (50%) required extensive skin excision. Twelve sternectomies (5 total and 7 partial) and 20 lateral chest wall resections were performed. In this latter group, 16 patients (80%) had at least three ribs resected. Resection extended to the lung (10 wedge resections, 2 lobectomies and 1 pneumonectomy) in 13 patients, diaphragm in 3, abdominal wall in 2, brachiocephalic and subclavian vessels in 5, superior vena cava in 1 and upper limb in 1. Stability of the chest wall was obtained with prosthetic material in 27 patients, including Marlex (n = 21), polytetrafluoroethylene (PTFE) (n = 4) and polyglactin (n = 2) meshes. After sternectomy, six patients had a methyl methacrylate mesh reinforcement while soft tissue reconstruction was carried out using the pectoralis major muscle (PM), either alone with skin advancement (n = 8) or as a myocutaneous flap in three males (unilateral n = 2, bilateral n = 1) and by a latissimus dorsi (LD) myocutaneous flap in one female. Muscle transposition was used to reconstruct defects of the lateral chest wall and included 10 LD, 6 PM and 2 serratus anterior (SA) muscles, with associated advancement of the diaphragm in two cases.(ABSTRACT TRUNCATED AT 250 WORDS)
大型原发性恶性胸壁肿瘤（PMCWT）根治性切除术后的重建手术仍在不断发展。1982年至1993年期间，连续32例患者（18例男性/14例女性）接受了根治性切除术，这些患者年龄中位数为47岁（范围12 - 77岁），患有源自胸壁骨骼（n = 15）或软组织（n = 17）的大型（中位数10 +/- 5.4 cm）PMCWT。9例（28%）在转诊前曾接受过手术切除。16例（50%）需要广泛切除皮肤。进行了12例胸骨切除术（5例全胸骨切除和7例部分胸骨切除）和20例胸壁外侧切除术。在后一组中，16例患者（80%）至少切除了三根肋骨。13例患者的切除范围扩展至肺（10例楔形切除术、2例肺叶切除术和1例全肺切除术），3例扩展至膈肌，2例扩展至腹壁，5例扩展至头臂静脉和锁骨下血管，1例扩展至上腔静脉，1例扩展至上肢。27例患者使用假体材料获得了胸壁稳定性，包括Marlex网片（n = 21）、聚四氟乙烯（PTFE）网片（n = 4）和聚乳酸网片（n = 2）。胸骨切除术后，6例患者使用甲基丙烯酸甲酯网片进行加固，同时使用胸大肌（PM）进行软组织重建，单独使用胸大肌并推进皮肤（n = 8），3例男性患者将其作为肌皮瓣使用（单侧n = 2，双侧n = 1），1例女性患者使用背阔肌（LD）肌皮瓣。肌肉移位用于重建胸壁外侧缺损，包括10例LD、6例PM和2例前锯肌（SA），2例患者同时推进了膈肌。（摘要截断于250字）
