胸骨肿瘤的外科治疗和修补方法

Surgical treatment of sternal tumors： resection of the tumors and reconstruction of the chest wall defects

目的探讨胸骨肿瘤的最佳手术切除和修补方法。方法回顾性分析1968年1月至2010年12月，经手术切除的胸骨肿瘤患者15例，按照en-bolck原则行外科手术切除和胸壁缺损修复。结果在6例胸骨柄肿瘤患者中，1例患者术后行钢丝固定，皮肤和皮下组织缝合；5例行胸大肌或者涤纶布修补，术后均呼吸正常，恢复顺利。在7例胸骨体肿瘤患者中，1例因缺损范围小，仅行钢丝固定，皮肤和皮下组织缝合，恢复顺利；2例胸大肌转移修补，2例胸大肌联合涤纶布修补后，均需呼吸机辅助呼吸；2例硬材料（有机玻璃或肽板）修补术后有1例呼吸机辅助呼吸。在2例全胸骨肿瘤患者中，因采用软材料修补，均需呼吸机辅助呼吸。结论胸骨柄肿瘤可以考虑应用软材料修补胸壁缺损，胸骨体肿瘤和全胸骨肿瘤建议切除后尽量采用硬材料修复。

Objective To investigate the efficacy of surgical treatment of sternal tumors and repairing methods of the chest wall defects. Methods Fifteen patients with sternal tumors were diagnosed and underwent resection of the sternal tumors according to the en-bolck principle and repair of the chest wall defects using various materials from January 1968 to December 2010 in our hospital. Results Of 6 patients with sternal manubrim tumors, one patient had reconstruction only with steel wire, other 5 patients healed completely after repair with soft materials. Of 7 patients with sternal body tumors, one patient recovered quickly without reconstruction because he had only partial resection; four patients had chest wall repair with soft materials, but they breathed hardly ; and two patients had chest wall reconstruction with rigid materials. One patient had ventilatory support, another patient recovered quickly. Ventilatory support was needed in two patients treated by subtotal sternectomy because they had chest wall repair with soft materials. Conclusions In surgical treatment of sternal tumors by manubrim sternetomy, the chest wall defects can be constructed with soft materials. After resection of sternal body tumors and subtotal sternectomy, the thoracic wall defects need to be reconstructed with rigid materials.