胸壁巨大肿瘤切除与修复重建

Resection,repair and reconstruction of huge tumor in chest wall

目的探索胸壁巨大肿瘤切除与修复重建的方法及疗效。方法回顾性分析2015年7月至2020年1月收治的4例胸壁巨大肿瘤的患者资料,其中软骨肉瘤2例,骨巨细胞瘤1例,乳腺癌转移1例。所有病例行肿瘤扩大切除,肿瘤切除后胸腔外露,2例采用补片+钛网重建,切口直接闭合,1例采用补片+背阔肌皮瓣修复创面,1例采用补片+钛网+背阔肌皮瓣重建。结果1例患者术后切口感染经清创后好转。所有患者随访2~6年,均未见肿瘤复发及转移。无反常呼吸,无呼吸困难等不适。结论胸壁巨大肿瘤切除困难,选择补片加钛网的重建方式更为合理安全,选择背阔肌皮瓣修复软组织缺损可取得良好效果。注重围手术期管理、多学科参与可使患者取得更好的疗效。

Objective To explore the methods and effects of resection,repair and reconstruction of huge chest wall tumors.Methods The data of 4 patients with huge chest wall tumors from July 2015 to January 2020 were retrospectively analyzed,including chondrosarcoma in 2 cases,giant cell tumor in 1 case,and metastasis of breast cancer in 1 case.All patients underwent extensive tumor resection and thoracic cavity was exposed after tumor resection.Two patients were reconstructed with patch and titanium mesh,and the incision was closed directly.One patient was repaired with patch and latissimus dorsi flap.One patient was reconstructed with patch,titanium mesh and latissimus dorsi flap.Results One case of postoperative incision infection improved after debridement.All patients were followed up for 2-6 years,no tumor recurrence and metastasis were found.All patients had no abnormal breathing,dyspnea and other discomfort.Conclusion It is difficult to resect the huge tumor in the chest wall.It is more reasonable and safe to choose the reconstruction method of patch and titanium mesh.The latissimus dorsi flap can achieve good results in repairing soft tissue defects.Paying attention to perioperative management and multidisciplinary participation can make patients achieve better curative effect.