背景:小儿胸壁肿瘤的切除会导致大的缺陷,需要重建功能和外观。已经描述了多种重建方法。我们对文献进行了系统回顾,以描述常用的方法和结果。
方法:对英文出版物进行了系统的文献检索,这些出版物描述了在≤21岁的患者中使用可植入材料进行胸壁肿瘤切除和重建。仅排除软组织切除术,胸骨切除术,和重建通过初级修复或单独的肌肉皮瓣。收集诊断数据,重建方法,和结果。将刚性胸壁重建与网格重建进行比较。
结果:共纳入文献55篇,共188例患者。中位年龄为12岁。大多数肿瘤是恶性的(n=172,91.5%),最常见的尤因肉瘤(n=65,34.6%),其次是未指定的肉瘤(n=34,18.1%),Askin肿瘤(n=16,8.5%;尤因肉瘤的一个子集)和骨肉瘤(n=16,8.5%)。切除3根肋骨的中位数(范围1-12)。非刚性网格最常见(n=138,73.4%),其次是刚性假体(n=50,26.6%)。术后并发症19例(16.8%),其中22.2%的患者发生脊柱侧弯。并发症无显著差异(20.5%刚性与10.6%非刚性,p=0.18)或脊柱侧凸(22.7%vs.14.0%,p=0.23)通过重建方法,但刚性重建后的并发症更可能需要手术(90.0%vs.53.9%,p=0.09)。中位随访时间为24个月。
结论:在这篇文献综述中,重建方法在术后总体并发症或脊柱侧凸发展方面无显著差异,然而,刚性重建后的并发症更可能需要手术干预。
方法:四级。
BACKGROUND: Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes.
METHODS: A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction.
RESULTS: There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing\'s sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin\'s tumor (n = 16, 8.5%; a subset of Ewing\'s sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months.
CONCLUSIONS: In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention.
METHODS: Level IV.