Malignant primary chest-wall tumours: techniques of reconstruction and survival
Malignant primary chest-wall tumours: techniques of reconstruction and survival
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DOI：
10.1016/j.ejcts.2009.12.046
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发表时间：
2010-07-01
影响因子：
3.4
通讯作者：
Janni, Alberto
中科院分区：
文献类型：
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作者：
Gonfiotti, Alessandro;Santini, Paolo Ferruccio;Janni, Alberto
目的：我们分析了原发性恶性胸壁肿瘤（PMCWT）的经验，重点是新的重建技术和生存率。方法：自1998年至2008年，我科对41例PMCWT患者（23例（56%）配偶，平均年龄48岁）进行了手术：软骨肉瘤n = 25；骨肉瘤 n = 8；尤文氏肉瘤 n = 2；其他 n = 6。我们进行了 9 例胸骨切除术和 32 例侧胸壁切除术（切除的肋骨中位数 = 3.5）。切除范围延伸至肺（n = 2）、膈肌（n = 3）、椎体（n = 3）、肩胛骨（n = 1）和上肢（n = 1）。通过刚性和非刚性的假体材料以及肌肉瓣获得稳定性。作为非刚性材料，我们主要使用聚四氟乙烯贴片（n = 24）。在过去的两年中，两名患者（一名全胸骨切除术和一名宽前胸壁切除术）采用由可塑钛连接杆和肋骨夹组成的刚性系统进行重建（斯特拉斯堡胸廓骨合成系统 - STRATOS，MedXpert GMbH，Heitersheim，德国）。 12 名患者（29.3%）添加了肌瓣。结果：没有围手术期死亡或明显的发病率，所有患者均在前 24 小时内拔管。平均随访 60.5 个月（范围 4-130 个月），总体 5 年和 10 年生存率分别为 61% 和 47%。软骨肉瘤组的 5 年和 10 年生存率为 80%。结论：PMCWT 中需要进行无肿瘤边缘的广泛切除，以尽量减少局部复发并有助于长期生存。 STRATOS 系统专为胸壁置换而开发，可实现牢固的重建，操作和固定简单，避免了宽胸壁切除中的不稳定或矛盾运动。 (C) 2010 年欧洲心胸外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objectives: We analysed our experience in primary malignant chest-wall tumours (PMCWTs) with an emphasis on a new reconstruction technique and on survival. Methods: From 1998 to 2008, 41 patients (23 (56%) mate, mean age 48 years) with PMCWT were operated in our unit: chondrosarcoma n = 25; osteosarcoma n = 8; Ewing's sarcoma n = 2; other n = 6. We performed nine sternectomies and 32 lateral chest-wall resections (median number of ribs resected = 3.5). Resections were extended to the lung (n = 2), diaphragm (n = 3), vertebral body (n = 3), scapula (n = 1) and upper limb (n = 1). Stability was obtained by a prosthetic material, rigid and non-rigid and a muscular flap. As non-rigid material, we mostly used a polytetrafluoroethylene patch (n = 24). In the past 2 years, two patients (one total sternectomy and one wide anterior chest-wall resection) were reconstructed with a rigid system composed of mouldable titanium connecting bars and rib clips (Strasbourg Thoracic Osteosyntheses System - STRATOS, MedXpert GMbH, Heitersheim, Germany). A muscular flap was added in 12 patients (29.3%). Results: There was no perioperative mortality or significant morbidity and all patients were extubated within first 24 h. At a mean follow-up of 60.5 months (range 4-130 months), the overall 5- and 10-year survival was 61% and 47%, respectively. In the chondrosarcoma group, 5- and 10-year survival was 80%. Conclusions: Wide resection with tumour-free margins is necessary in PMCWT to minimise local recurrence and to contribute to long-term survival. The STRATOS system, developed for chest-wall replacement, allows a firm reconstruction, simple to handle and to fix, avoiding instability or paradoxical movement also in wide chest-wall resections. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.