目的:评价膨体聚四氟乙烯(ePTFE)网片在胸壁重建中的成功。
方法:我们回顾性分析了接受ePTFE(Gore-Tex®)胸壁重建的患者。主要结果是与网格相关的事件,定义为与网格相关的重新操作(例如,需要有/无外植体清创的网状感染,有外植体的肿瘤复发)和/或有/无疝的结构开裂/网片松动。报告了人口统计学和手术结果。
结果:246个重建满足纳入(1994-2021)。55例(22.4%)重建术后中位1.08年(IQR0.08,4.53)内发生网状相关事件;那些没有稳定胸部的患者中位为3.9年(IQR,1.59,8.23,p<0.001)。41(16.6%)的网眼被感染,需要再次操作。88%(36/41)被完全外植;8.3%(3/36)需要额外的网格放置。网孔相关事件的预测因素是胸壁放疗之前(OR=9.73,CI3.47至30.10,p<0.001),较高的BMI(OR1.08,CI1.01至1.16,p=0.019),和较大的缺陷(OR1.48,CI1.02至2.17,p=0.042)。既往胸壁放疗患者发生网状相关肥胖事件的风险较高。
结论:大多数(78%)使用ePTFE网片的患者在中位4年后重建稳定。肥胖,较大的缺陷,和先前的胸壁放疗与网状物相关事件的较高风险相关,主要是由于网状物感染.17%的重建者因网状感染而再次手术;88%被完全移植。只有8%需要更换网格,这表明有经验的外科医生可以安全地管理它们而无需更换。未来的研究应该比较高风险患者的各种网格,以帮助指导最佳网格选择。
OBJECTIVE: To evaluate the success of expanded polytetrafluoroethylene (ePTFE)
mesh in chest-wall reconstruction.
METHODS: We retrospectively reviewed patients who underwent ePTFE (Gore-Tex®) chest-wall reconstruction. The main outcome was a
mesh-related event, defined as a
mesh-related reoperation (e.g.,
mesh infection requiring debridement with/without explant, tumor recurrence with explant) and/or structural dehiscence/mesh loosening with/without a hernia. Demographics and surgical outcomes were reported.
RESULTS: 246 reconstructions met inclusion (1994-2021). Fifty-five (22.4%) reconstructions had mesh-related events within a median of 1.08 years (IQR 0.08, 4.53) postoperatively; those without had a stable chest for a median of 3.9 years (IQR, 1.59, 8.23, p<0.001). Forty-one (16.6%) of meshes became infected, requiring reoperation. Eighty-eight percent (36/41) were completely explanted; 8.3% (3/36) required additional mesh placement. Predictors of
mesh-related events were prior chest-wall radiation (OR=9.73, CI 3.47 to 30.10, p<0.001), higher BMI (OR 1.08, CI 1.01 to 1.16, p=0.019), and larger defects (OR 1.48, CI 1.02 to 2.17, p=0.042). The risk of
mesh-related events with obesity was higher with prior chest-wall radiation.
CONCLUSIONS: Most (78%) patients with an ePTFE mesh had a stable reconstruction after a median of 4 years. Obesity, larger defects, and prior chest-wall radiation were associated with a higher risk of a mesh-related event mostly due to
mesh infections. Seventeen percent of reconstructions had reoperation for mesh infection; 88% were completely explanted. Only 8% required replacement mesh, suggesting that experienced surgeons can safely manage them without replacement. Future studies should compare various meshes for high-risk patients to help guide the optimal mesh selection.