Feldmeier J J, Heimbach R D, Davolt D A, Court W S, Stegmann B J, Sheffield P J
Department of Radiation Oncology, Grace Hospital, Detroit, Michigan, USA.
Undersea Hyperb Med. 1995 Dec;22(4):383-93.
Since 1979, 23 cases of radiation-induced chest wall necrosis have been treated in the Hyperbaric Medicine Departments of Southwest Texas Methodist Hospital and the Nix Hospital, San Antonio, Texas. Eight cases involved soft tissue only. Six of eight (75%) patients with soft tissue involvement healed without requiring surgical debridement, although four patients (50%) did have flaps or grafts. Fifteen patients had bony and soft tissue necrosis. Eight of these patients (53%) resolved with adjunctive hyperbaric oxygen (HBO), but all required aggressive surgical debridement including skeletal resection. Four (27%) had reconstructive flaps as well. Six patients (40%) with bony necrosis who had either no or incomplete debridement failed to heal. Three patients (13%)(two soft tissue and one bony) were found to have residual tumor during HBO and were discontinued from treatment. HBO is an effective adjunctive therapy for soft tissue chest-wall, radiation-induced necrosis, but must be coupled with appropriate debridement to include surgical removal of all necrotic bone to ensure a successful outcome of bony plus soft tissue necrosis.
自1979年以来，得克萨斯州圣安东尼奥市西南得克萨斯卫理公会医院和尼克斯医院的高压氧医学科共治疗了23例放射性胸壁坏死病例。其中8例仅累及软组织。8例软组织受累患者中有6例（75%）未经手术清创即愈合，不过有4例患者（50%）确实接受了皮瓣或植皮手术。15例患者出现骨与软组织坏死。其中8例患者（53%）经辅助高压氧（HBO）治疗后病情得到缓解，但均需进行包括骨骼切除在内的积极手术清创。另外4例（27%）还接受了重建皮瓣手术。6例骨坏死患者（40%）未进行清创或清创不完全，未能愈合。3例患者（13%）（2例软组织坏死和1例骨坏死）在接受HBO治疗期间发现有残留肿瘤，遂停止治疗。HBO是治疗放射性胸壁软组织坏死的一种有效辅助疗法，但必须结合适当的清创，包括手术切除所有坏死骨，以确保骨与软组织坏死均能取得成功的治疗效果。
