摘要
目的:总结复杂胸壁肿瘤的临床特点与外科治疗经验。方法:回顾性分析上海交通大学医学院附属新华医院心胸外科2011年1月至2015年12月期间行复杂胸壁肿瘤切除重建手术患者的临床病理学资料,对患者临床特点、诊治方法及随访结果进行分析研究。结果:共入组25例患者,其中男16例,女9例。对25例患者均行完整肿瘤切除、胸壁重建术。4例上腔静脉或头臂静脉受侵者行人工血管置换术,2例胸骨受侵者行部分或完全胸骨切除术,1例因上腔静脉内癌栓形成行体外循环辅助胸壁肿瘤切除。术后病理诊断:恶性19例,良性6例;骨肉瘤6例(其中1例体外循环下行肿瘤切除),胸腺癌3例(均行人工血管置换术),浆细胞瘤2例,孤立性胸膜纤维瘤2例,横纹肌肉瘤2例,神经母细胞瘤2例,神经纤维瘤2例,梭形细胞癌2例,纵膈恶性间皮瘤1例(血管置换),纵膈脉管瘤1例,纵膈慢性炎性病变1例(侵犯胸骨),胸骨去分化软骨肉瘤1例(侵犯胸骨)。结论:完整切除肿瘤、一期胸壁重建是复杂胸壁肿瘤治疗的主要治疗方法。对大血管侵犯患者行新辅助放化疗后行血管置管术,对癌栓形成者行体外循环辅助取栓,对巨大胸壁肿瘤患者行肿瘤切除后钛板胸壁重建,必要时辅以手术前后放化疗,有助于提高肿瘤切除率并改善患者预后。
Objective： To summarize the clinical characteristics and surgical treatment for complex neoplasms involving the chest wall, Methods： The clinical and pathologic material as well as the of the surgical treating process were collected in patients with tumors invading the chest wall in Xinhua hospital affiliated to Shanghai Jiaotong University school of medicine from January 2011 to December 2015. The therapeutic efficacy and follow up data were also analyzed. Results： 25 patients were enrolled in our study including 19 men and 9 women. All the neoplasm were radically resected and chest wall reconstruction was performed in all the patients above. Among the 25 cases, artificial vascular replacement was applied in 4 cases because their superior vena cava or brachioeephalic veins was invaded. Sternum was partly or completely removed in 2 patients. There was another patient receiving tumor resection under extracorporeal circulation for the cancer cell embolus formation. The pathological diagnosis was as follows： 6 of the 19 malignant tumor were osteosarcoma; 3 of them were thymic carcinoma; In the rest of the malignant tumors, we also found 2 cases of plasmacytoma, 2 rhabdomyosarcoma, 2 neuroblastoma, 2 spindle cell carcinoma, 1 dedifferentiated chondrosarcoma and lmesothelioma. Benign neoplasm was observed in 6 cases including 2 solitary fibrous tumor, 2 neurofibroma, 1 vascular tumor and 1 inflammatory tumor. Conclusions： It was crucial to remove the mass completely and perform chest wall reconstruction primarily in treating complex neoplasms involving the chest wall. Artificial vascular replacement, neoadjuvant chemoradiotherapy and extracorporeal circulation may contributed to improve the prognosis for patients with superior vena cava or brachiocephalic veins invaded or for those with cancer cell embolus formation.
作者
王磊
胡丰庆
李国庆
肖海波
胡睿
王明松
WANG Lei HU Feng-qing LI Guo-qing XIAO Hai-bo HU Rui WANG Ming-son(Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, Chin)
出处
《现代生物医学进展》
CAS
2016年第36期7029-7033,共5页
Progress in Modern Biomedicine
基金
上海市科技人才计划项目(15YF1407800)
关键词
胸壁肿瘤
外科治疗
血管置换
体外循环
Neoplasms Involving the chest wall
Surgical treatment
Artificial vascular replacement
Extracorporeal circulation
