Oda M, Shimizu J, Matsumoto I, Hayashi Y, Ohta Y, Go T, Osari A, Kinsen H, Watanabe Y
Department of Surgery, Kanazawa University, School of Medicine, Japan.
Kyobu Geka. 1996 Jan;49(1):17-20.
Twenty-three patients underwent chest wall reconstruction in our department. The underlying disease was bronchial carcinoma in 14, urachus tumor in 2, breast cancer in 1, renal cancer in 1, thymic Hodgkin's lymphoma in 1, tuberculosis in 1, fibrosarcoma in 1, and pseudoaneurysm of the aortic arch caused by reconstructed material in 1. An average of 3.4 ribs were resected in 18 patients and sternectomies were performed in 5. Chest wall reconstruction was performed with Marlex mesh in 14, Marlex mesh with methyl methacrylate in 5, Marlex mesh with steel wire in 1, Marlex mesh with omentopexy in 1, Marlex mesh with A-O plate in 1, and net formation with catgut in 1. There was no operative death. Postoperative wound infection occurred in only 1 patient with Marlex mesh cleaned by irrigation and administration of antibiotics. Three patients with Marlex mesh and metyl methacrylate required removal of the prosthetic material postoperatively because of wound infection in 1, seroma in 1, and dislocation of the former reconstructed material in 1. One patient with Marlex mesh and steel wire had protrusion of the wire under the skin and the wire was removed. Eleven patients of lung cancer died at 2-17 months after surgery. In conclusion, chest wall reconstruction with Marlex mesh had excellent results, and chest wall resection and reconstruction for malignancy could be good palliation.
我科对23例患者进行了胸壁重建。基础疾病为支气管癌14例、脐尿管肿瘤2例、乳腺癌1例、肾癌1例、胸腺霍奇金淋巴瘤1例、肺结核1例、纤维肉瘤1例、人工材料致主动脉弓假性动脉瘤1例。18例患者平均切除3.4根肋骨,5例行胸骨切除术。14例采用Marlex网片进行胸壁重建,5例采用Marlex网片加甲基丙烯酸甲酯,1例采用Marlex网片加钢丝,1例采用Marlex网片加网膜固定术,1例采用Marlex网片加AO钢板,1例采用肠线编织成网。无手术死亡。仅1例采用Marlex网片的患者术后伤口感染,经冲洗及使用抗生素后治愈。3例采用Marlex网片加甲基丙烯酸甲酯的患者术后因伤口感染1例、血清肿1例、原重建材料移位1例而需取出假体材料。1例采用Marlex网片加钢丝的患者钢丝在皮下突出,予以取出。11例肺癌患者术后2至17个月死亡。总之,Marlex网片胸壁重建效果良好,恶性肿瘤胸壁切除重建可起到较好的姑息作用。