背景:原发性胸壁肿瘤占所有胸部肿瘤的5%,占所有原发性肿瘤的1%。软骨肉瘤是一种罕见的实体瘤,年发病率为每百万人每年<0.5。它主要发生在骨盆和股骨,偶尔发生在扁骨,如胸骨和肋骨,很少侵入肺组织。胸壁软骨肉瘤仅占所有软骨肉瘤的5-15%。根治性手术常导致大范围的胸壁缺损,特别是当范围超过6厘米×6厘米并涉及胸骨时,脊柱,或多个连续的肋骨。胸壁骨的重建应考虑恢复胸部的完整性和稳定性,防止胸壁软化和呼吸异常,保证呼吸循环的稳定性。胸壁重建可以帮助恢复胸部硬度和完整性,预防肺疝和呼吸异常,同时也确保了积极的美学结果。胸壁重建包括胸膜的重建,骨结构,和软组织。
方法:在我们的成年男性案例中,切除第三和第四肋前软骨肉瘤后,普通解剖板被成形并用螺钉固定在第三肋的残端上,以确保胸部的稳定性,同时保持胸部的活动性。应用疝网片修剪后,缝合胸壁缺损以完成缺损区域的胸膜重建。此术式能有效维持胸膜腔的稳定性,为胸壁软组织提供更有效的支撑,促进上肢功能和肺功能的恢复。
结论:巨大胸壁软骨肉瘤的根治性手术常导致大范围的胸壁缺损。胸壁重建需要同时进行,以恢复胸壁的完整性和稳定性,避免胸壁软化和呼吸异常,并确保呼吸循环的稳定性。使用“三明治”法进行胸壁重建,其中解剖板与疝气网片和肌肉软组织相结合,在此期间,胸膜,骨结构,软组织被重建,可以为胸壁软组织提供更有效的支撑,有效防止术后肌肉组织塌陷,避免术后呼吸异常,促进术后上肢功能和肺功能的恢复。这是一种非常有效的胸壁重建方法。
BACKGROUND: Primary chest wall tumors account for 5% of all thoracic neoplasms and 1% of all primary tumors. Chondrosarcoma is a rare solid tumor, with an annual incidence of <0.5 per million people per year. It predominantly occurs in the pelvis and femur, occasionally occurs in flat bones such as the sternum and
ribs, and rarely invades lung tissue. Chest wall chondrosarcomas represent only 5-15% of all chondrosarcomas. Radical surgery often leads to a large range of chest wall defects, especially when the range exceeds 6 cm × 6 cm and involves the sternum, spine, or multiple consecutive
ribs. The reconstruction of the chest wall bone should be considered to restore the integrity and stability of the chest, prevent chest wall softening and abnormal breathing, and ensure the stability of respiratory circulation. Chest wall reconstruction can help restore thoracic hardness and integrity, prevent lung hernia and abnormal breathing, while also ensuring a positive aesthetic outcome. The chest wall reconstruction includes reconstruction of the pleura, bony structures, and soft tissues.
METHODS: In our case of an adult male, after the resection of the third and fourth anterior rib chondrosarcoma, the common anatomical plate was shaped and fixed to the stump of the third rib with screws to ensure the stability of the thorax while retaining the mobility of the thorax. After applying hernia mesh pruning, the chest wall defect was stitched to complete the pleural reconstruction of the defect area. This procedure can effectively maintain the stability of the pleural cavity, provide more effective support for the chest wall soft tissue, and promote the recovery of upper limb function and lung function.
CONCLUSIONS: The radical surgery of giant chest wall chondrosarcoma often leads to a large range of chest wall defects. Chest wall reconstruction needs to be carried out at the same time to restore the integrity and stability of the chest wall, to avoid chest wall softening and abnormal breathing, and to ensure the stability of respiratory circulation. Using the \"sandwich\" method for chest wall reconstruction, in which an anatomical plate is combined with hernia mesh and muscle soft tissue, and during which pleura, bony structure, and soft tissues are reconstructed, can provide more effective support for chest wall soft tissue, effectively prevent postoperative muscle tissue collapse, avoid postoperative abnormal breathing, and promote the recovery of postoperative upper limb function and lung function. It is a very effective method for chest wall reconstruction.