胸壁肿瘤切除后胸壁重建方法的探讨

Study on chest－wall reconstruction after chest－wall tumor resection

目的：探讨胸壁肿瘤切除后胸壁重建的方法。方法：从1986－1998年对29例胸壁肿瘤切除后病人采用多种术式进行了胸壁重建，骨性胸壁的修复包括采用自体组织（阔筋膜、肌瓣、大网膜）及人工替代物（金属支架、钛合金片、Dacron、及Dacron十骨水泥十Dacron三文治式复合体）。皮肤软组织层的修复主要用岛状背阔肌皮瓣及乳房瓣。结果：无手术死亡及局部复发，无严重并发症，恶性肿瘤术后5年生存率为52％。结论：骨性胸壁缺损6cmX6cm以上需行胸壁重建，一般可用自体组织，必要时加用金属支架，大面积缺损（10cmx10cm以上）以三文治式修复法为理想，皮肤软组织缺损的修复可选用岛状背阔肌皮瓣及乳房劈裂瓣。

Aim: to study the operating procedure and repairing materials of chest－wall reconstruction. Method: From 1986 to 1988. 29 patients underwent chest－wall resection using several kinds of operating procedure and materials to reconstruct the chest－wall defects. The materials to repair the bony chest－wall included autografts(tensor fascial Plate, muscle nap, gnat omentum nap), and artificial materials (metal framework, titanuium plate, dacron, and prothesis of sandwich type). Result: No'operation death and local failure. No serious complication. The 5 year survival rate was 52%. ConcluSion: The area of bony chest－wall defects may be repaired, defects under 10 x 10cm can use autograft for repairing, using metal framework tO supPOrt when necessory. But while the area of defects was over 10 x 10cm, the better material is prothesis Of sandwich type. The island latissimus dorsi myocutanous nap and split breast flap are useful for the repairing of skin and soft tissues defects.