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[全层胸壁切除与重建]

[Resection and reconstruction of full thickness chest wall].

作者信息

Ayabe H, Tagawa Y, Hara S, Tsuji H, Oka T, Morinaga M, Shingu H

机构信息

First Department of Surgery, Nagasaki University School of Medicine, Japan.

出版信息

Kyobu Geka. 1996 Jan;49(1):21-5.

PMID:8558801
Abstract

Nine patients underwent full thickness chest wall resection and reconstruction in our department between January 1981 and December 1994. There were chest wall recurrence of breast cancer in 5 cases, primary chest wall chondrosarcoma in 2, primary chest wall malignant fibrous histiocytoma in 1 and metastatic sternal renal cell carcinoma in 1. Seven of 9 cases underwent partial sternal resection. Sizes of chest wall defects were from 10 x 7 cm to 15 x 14 cm. In eight cases of 9, chest wall reconstruction was by double Marlex mesh repairs and various flaps (major pectoral muscle in 3, major pectoral myocutaneous flap in 2, latissimus dorsi myocutaneous flap in 1 and pedicled omentum in 1). The last case underwent repair with rectus abdominis myocutaneous flap without mesh. There was no operative death. Postoperative complications occurred in 4 patients: partial skin necrosis in 2, skin dehiscence in 1 and respiratory failure in 1. Eight cases are alive now from 9 months to 14 years and 8 months after chest wall reconstruction. One patient with metastatic renal cell carcinoma died of recurrence 3 years after operation. Full thickness chest wall resection and reconstruction is a safe operation and may provide a long-term survival.

摘要

1981年1月至1994年12月期间,我科对9例患者进行了全层胸壁切除及重建手术。其中,5例为乳腺癌胸壁复发,2例为原发性胸壁软骨肉瘤,1例为原发性胸壁恶性纤维组织细胞瘤,1例为转移性胸骨肾细胞癌。9例患者中有7例接受了部分胸骨切除。胸壁缺损大小为10×7厘米至15×14厘米。9例中的8例采用双层Marlex网片修复及各种皮瓣进行胸壁重建(3例采用胸大肌皮瓣,2例采用胸大肌肌皮瓣,1例采用背阔肌肌皮瓣,1例采用带蒂大网膜)。最后1例采用腹直肌肌皮瓣无网片修复。无手术死亡病例。4例患者出现术后并发症:2例部分皮肤坏死,1例皮肤裂开,1例呼吸衰竭。9例患者中8例在胸壁重建后9个月至14年8个月存活。1例转移性肾细胞癌患者术后3年死于复发。全层胸壁切除及重建是一种安全的手术,可能提供长期生存。

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