Yokote K, Osada H
Third Department of Surgery, St. Marianna Medical College, Kawasaki, Japan.
Kyobu Geka. 1996 Jan;49(1):38-41.
Fifty two patients with chest wall resection were reviewed, with emphasis upon 16 patient with chest wall reconstruction. The latter 16 patient consisted of 6 with metastatic tumor, 3 of primary lung cancer, 2 of breast cancer, one of primary chest wall tumor, and others. Before 1985, reconstruction after chest wall resection was conducted in four cases by using methyl methacrylate (Resin). One patient developed erosion of the overlying skin due to protrusion of the edge of Resin-plate with delayed wound healing. Since 1986, we have employed muscle or myocutaneous flap and/or Marlex mesh in reconstruction of the chest wall defect. Twelve patients underwent surgery in this way. Neither paradoxical movement of the chest wall nor respiratory distress developed in the postoperative course of any patient. Thirty six of fifty two patients underwent chest wall resection without following reconstruction as in the former group. Of them one patient of anterior chest wall resection developed respiratory failure. We conclude that rib resection involving as many as three or more in the anterior chest wall, or four rib resection or more in the lateral chest wall, if the area of the defect is greater than 100 cm2, chest wall reconstruction is indicated. Moreover, we believe that muscle or myocutaneous flap and/or Marlex mesh in the best way of reconstruct in following chest wall resection.
对52例胸壁切除术患者进行了回顾性研究，重点关注16例胸壁重建患者。后16例患者包括6例转移性肿瘤患者、3例原发性肺癌患者、2例乳腺癌患者、1例原发性胸壁肿瘤患者及其他患者。1985年前，4例胸壁切除术后重建采用甲基丙烯酸甲酯（树脂）。1例患者因树脂板边缘突出导致覆盖皮肤糜烂，伤口愈合延迟。自1986年以来，我们采用肌肉或肌皮瓣和/或Marlex网片重建胸壁缺损。12例患者采用这种方法进行手术。术后所有患者均未出现胸壁反常运动或呼吸窘迫。52例患者中有36例如前一组一样进行了胸壁切除但未进行后续重建。其中1例前胸壁切除患者发生呼吸衰竭。我们得出结论，如果前胸壁切除三根或更多肋骨，或侧胸壁切除四根或更多肋骨，且缺损面积大于100平方厘米，则需要进行胸壁重建。此外，我们认为肌肉或肌皮瓣和/或Marlex网片是胸壁切除术后最佳的重建方式。
