胸壁大块缺损外科重建71例报告

Surgical reconstruction of giant chest wall defect:a 71 cases report

目的探讨胸壁大块缺损后不同外科技术重建的效果。方法1995年9月至2005年9月对71例不同病因的胸壁大块缺损患者采用多种方法进行胸壁重建。骨性胸廓重建采用自体组织(肋骨条、阔筋膜、肌瓣)或人工材料(Dacron片、聚四氟乙烯网片+钛合金条、金属丝支架加大网膜片、Dacron和骨水泥构成的三明治式复合体)。皮下软组织修复主要应用转移皮瓣、肌皮瓣或大网膜瓣。结果全组无手术死亡和局部肿瘤复发,2例因感染摘除金属植入物。术后呼吸功能良好,无反常呼吸运动。结论背阔肌瓣和大网膜瓣修复软组织效果较好,后者对因感染引起的胸壁缺损效果更佳。Dacron片和骨水泥构成的三明治式复合体适用于大块骨性胸廓缺损的重建。

Objective To evaluate the results of chest wall reconstruction in patients with giant chest wall defect. Methods From Sep. 1995 to Sep. 2005,71 patients with huge chest wall defect underwent chest wall reconstruction using several kinds of procedures and materials. The materials to repair the bony chest- wall includes autografts （tensor faseial plate, muscle flap, great omentum flap）, and artificial materials （Dacron, PTFE ＋ Titanuium plate, metal framework, and prosthesis sandwich type combined with Dacron and methylmethaerylate）. The materials for the soft tissue reconstruction include Regional rotation flap,latissimus dorsi myocutaneous flap and great omentum flap. Results There were no operating death and local failure. There were 2 patients needed to draw out metal graft beeaused of infection. The postoperative respiratory functions were normal. No paradoxical respiration occurred in this group. Conclusion Latissimus dorsi muscle flap and great omentum flap are useful for repairation of soft tissue defect,and the later is priority for defects caused by infection. The better material for chest wall to patients with huge bony defect is prosthesis of sandwich type combined with Dacron and methylmethacrylate.