肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响

Reconstructive strategy of oncologic complex chest wall defect and its positive effect on tumor treatment

复杂性胸壁缺损的修复一直是一项极具挑战性的工作。肿瘤性复杂性胸壁缺损的修复决策及其执行困难是限制胸壁肿瘤治疗方法选择及影响预后的重要因素之一。皮瓣解剖学研究的深入、胸壁支持结构重建技术的进步、显微外科技术的发展、麻醉护理的发展、对综合治疗的重视和治疗手段的进步等,使传统认为不可切除的胸壁肿瘤得以彻底地切除和安全有效地修复,从而使与缺损修复相关的肿瘤切除及辅助治疗的禁忌证缩减到最小程度,有效地提高了胸壁肿瘤患者的生存质量,并很大程度上延长了生存率。作者以湖南省肿瘤医院整形外科15年565例胸壁肿瘤切除后修复重建的临床资料为依据,充实了胸壁肿瘤切除及修复的策略:(1)可靠的胸壁骨性支架重建;(2)有效的软组织修复;(3)麻醉及护理与手术团队的合作;(4)系统有序的综合治疗。并进一步明确了复杂胸壁肿瘤切除及重建的细节理念,包括胸部肿瘤治疗中加强多学科合作的密切性和科学性,整形外科医生参与肿瘤治疗整体规划的主动性和时机前移等。

Reconstruction of complex chest wall defects has always been a challenging surgical modality.The management and implementation precise oncological principles in tumor resection and multi-modal treatment decision-making in complex chest wall defect reconstruction are imperative and directly affect the patients’pathway and prognosis.The comprehensive knowledge of complex and composite flaps anatomy,the inherent utilization of technologically advanced chest wall supporting structure substitutes,the innovations in reconstructive microsurgical techniques,the advances in anesthesia and peri-operative clinical care,the emphasis on a multi-disciplinary management approach,etc;allow resection of previously thought unresectable chest wall tumors and enable optimal reconstructive and safe short and long term outcomes.Contraindications of complex chest wall tumors and adjunct surgical management techniques are significantly relevant to the outcomes following a sustainable chest wall reconstruction to enable high survival rates and quality of life.Over the last 15 years,at the Department of Plastic Surgery,Hunan Cancer Hospital,565 cases of complex chest wall tumor resections and simultaneous reconstructions,enhanced our understanding of management strategies of complex chest wall oncological reconstruction as follows:(1)Multi-disciplinary management approach involving,anesthetics,nursing and surgical teams;(2)Reliable reconstruction of chest wall skeletal stability;(3)Sufficient soft tissue coverage;(4)Medical treatments of oncological chemotherapies and radiotherapies.A comprehensive analysis of current concepts and algorithmic approach in complex oncological chest wall resection and reconstruction is presented and clarified,along with an enlightened reported insight blend of clinical experience and scientific reports of a multi-disciplinary management of this challenging surgical modality:the"unresectable"complex chest wall tumors,and the important role of plastic surgeons in the initiation plan and implement of overall tumor treatment.