肺癌根治术后胸壁缺损重建方法的探讨

Radical surgery of lung cancer with chest wall invasion and reliable methods of chest wall reconstruction

目的 探讨肺癌直接侵犯胸壁的根治性手术和胸壁重建的不同方法和效果.方法 回顾性总结27例肺癌直接侵犯胸壁根治手术的临床资料,行肺叶切除24例,全肺切除3例,所有患者手术中同时切除肺癌直接侵犯的胸壁,胸壁切除范围从6.5 cm×5.4 cm×5.0 cm至15.5 cm×12.5 cm×10.0 cm,切除肿瘤所侵犯的肋骨1～4根,采用涤纶布修复胸膜,采用有机玻璃、钢丝编网、网格状钛合金板修复骨性胸廓,采用邻近肌肉瓣和带蒂肌肉瓣修补缺损胸壁肌肉.结果 术后病理检查均为非小细胞肺癌,其中鳞癌22例,腺癌5例.术后出现肺部感染6例,胸壁出血1例,胸壁感染1例.1、3、5年生存期分别为77.9%、58.3%、29.1%.结论 肺癌直接侵犯胸壁的患者在治疗上应积极采取根治性外科手术,要以缺损面积大小,选择不同重建方法和修补材料,并辅以其他方法进行综合治疗.

Objective To study the efficacy of radical surgery for the invasion of chest wall by lung cancers and the different methods of chest wall reconstruction. Methods A retrospective analysis of clinical data was conducted in 27 cases of lung cancer with chest wall invasion in this hospital. 24 cases received lobectomy, 3 cases received pneumonectomy, and all cases received wall reconstruction. The size of chest wall defect after resection ranged from 6.5 cm × 5.4 cm × 5.0 cm to 15.5 cm × 12.5 cm ×10.0 cm. The number of rib resection for each patient ranged from 1 to 4. The reconstructive methods were as follows： using polyester fabric to reconstruct costal pleura, using plexiglass, stainless steel wire and grid-like titanium plate to reconstruct bone defect, and using nearby muscle flap and pedunculated muscle flap to reconstruct muscle defect. Results Pathologic diagnosis was non-small cell lung cancer,including 22 cases of squamous cell carcinomas and 5 adenocarcinomas. There were pulmonary infections in 6 cases, chest hemorrhage in 1 case and chest purulence in 1 case. One-year survival was 77. 9 %,3-yearsurvival was 58.3 %, and 5-year survival was 29. 1 %. Conclusion The lung cancer with chest wall invasion is advisable to make active use of radical surgery. The different methods and repair materials are chosen to reconstruct the chest wall defect, supplemented by comprehensive treatments.