原发性胸骨恶性肿瘤切除后同种异体髂骨移植的远期疗效

Resection of sternal tumors and reconstruction of the thorax with autologous iliac bone：a long-term follow-up

目的探讨原发性胸骨恶性肿瘤手术广泛切除后，用同种异体髂骨移植修补胸前区胸廓的巨大缺损，并辅以化疗及免疫治疗的远期疗效。方法自1994年10月至1997年4月对1例男性（44岁）与2例女性（49岁、34岁）原发性胸骨恶性肿瘤患者行手术广泛切除（范围包括肿瘤及距瘤缘至少2cm范围内的所有组织并清扫周围淋巴结），并采用同种异体髂骨移植修补胸廓缺损，术后辅以化疗及免疫治疗。同种异体髂骨在骨库于深低温下（-80℃～-40℃）保存半年以上，术中置40℃生理盐水中复温，剪裁成胸前缺损大小，予以修补。结果3例原发性胸骨恶性肿瘤患者术后伤口愈合良好。1例有假关节形成，1年后愈合；1例术后5个月切口处出现窦道并有脓性分泌物，经清创处理后愈合。3例患者术后病理学诊断分别为胸骨骨肉瘤、高分化软骨肉瘤及软骨肉瘤。3例患者现已分别存活12年、9年与8年，随访观察无瘤生存。结论原发性胸骨恶性肿瘤在病变未扩散前，积极进行手术广泛切除并采用同种异体髂骨移植修补胸廓缺损，术后辅以化疗及免疫治疗，预后良好，患者可长期较高质量生存。同种异体髂骨经深低温保存，移植后无排异及明显骨吸收，是理想的修复材料。

Objective Radical surgical resection is still the main method to treat the patients with primary malignant sternal tumors. Homologous iliac bone can be used for reconstruction of the chest wall to repair the defect and maintain the stability, then postoperative chemotherapy and immunotherapy will be performed. To discuss the long term effect of these therapies. Methods Between October 1994 and April 1997, 3 patients with primary malignant sternal tumors were treated in Tianjin Cancer Hospital and Tianjin Third Central Hospital. There were one male and two females with the ages of 34, 44, 49, respectively. Each patient was accepted a radical resection of the tumor（the extension including the tumor, all tissue surrounding at least 2 cm from the edge and lymph nodes）. Homologous iliac bone which was stored at -80℃ for half a year. During the operation, the homologous iliac bone was thawed in normal saline at 40℃, and was contoured before the transplantation. All patients had received postoperative chemotherapy and immunotherapy. Results Three patients with primary malignant sternal tumors underwent en bloc resection, the chest wall defect after resection was reconstructed by homologous iliac bone. The incisions healed good. One patient had a pseudoarthrosis, which disappeared one year later. One patient had an sinusoid duct, which healed after debridement half a year later. In the 3 cases, postoperative pathologies were： sternal osteosarcoma, well differentiated chondrosarcoma and chondrosarcoma. All patients have been living for 12, 9, and 8 years, respectively, without any sign of recurrence. Conclusion Aggressive surgical treatment is effective for patients with local advanced primary sternal malignancy. Postoperative chemotherapy and immunotherapy are highly recommended. The chest wall defect after resection of the affected sternum can be reconstructed by homologous iliac bone. The prognosis of these patients are significantly encouraged.