胸骨肿瘤切除后用钛网重建胸壁12例临床分析

Clinical analysis on 12 cases of resection of sternal tumors and reconstruction of the chest wall by titanium mesh

目的探讨胸骨肿瘤的临床特点、诊治方法与手术效果。方法回顾复旦大学附属中山医院胸外科2005年11月至2014年5月根治性切除并以钛网重建胸壁缺损的胸骨肿瘤患者共12例,对其临床特点、诊治方法、病理及随访结果进行分析。结果 12例患者均能扪及胸骨肿块,其中6例伴有不同程度的胸痛症状。切除胸骨肿瘤后均采用钛网修补行一期胸壁重建。术后并发纵隔血肿1例、急性左心衰1例、肺不张1例,无围手术期死亡。术后病理诊断:软骨肉瘤5例,软骨瘤1例,浆细胞瘤2例,横纹肌肉瘤1例,低度恶性间叶源性肿瘤1例,转移性甲状腺滤泡癌1例,PNET/Askin瘤1例。随访至2014年5月,其中2例已死亡,均为软骨肉瘤患者,术后分别生存5个月和24个月。结论胸骨肿瘤以恶性为主,及时充分的手术切除及钛网一期胸壁重建安全有效。

Objective To investigate the clinical features,diagnostic methods and surgical effects of the sternal tumor.Methods The clinical data of 12 patients of resection of sternal tumor and reconstruction of the chest wall by titanium wesh in Zhongshan Hospital,Fudan University between Nov.2005 and May.2014 was analyzed retrospectively.The clinical presentation,diagnosis,treatment and result of the patients were evaluated.Results All the 12 patients were admitted in with sternal occupation and 6 cases of them with pain in the sternum.Reconstruction of the defect using a titanium mesh was performed after resection of the tumor.Postoperative complications included hemomediastinum （1 case）,acute left heart failure （1 case） and atlectasis （1 case）.Postoperative pathological diagnosis showed that 5 cases with chondrosarcoma,1 case with chondroma,2 cases with plasmocytoma,1 case with rhabdomyosarcoma,1 case with low grade malignant mesenchymal tumors,1 cases with metastatic thyroid follicular cell cancer,and 1 case with PNET/Askin tumor.Follow up to May 2014,2 patients of chondrosarcoma were dead.The postoperative survival time was 5 month and 24 month respectively.Conclusions Sternal tumor mainly appeared malignant.Resection of the tumor and reconstruction of the chest wall defect by titanium mesh was safe and effective.