胸壁惡性腫瘤切除者選擇性使用骨科鋼板進行胸壁重建

Patient Selection for Chest Wall Reconstruction Using Bone Plates after Resection of Chest Wall Malignancies

切除胸壁惡性腫瘤所造成胸壁缺損，其胸壁重建對術後胸部護理極為重要。本文是描述在3 年期間的胸壁惡性腫瘤手術，選擇性使用骨科鋼板進行胸壁重建，並評估胸壁惡性腫瘤手術成果。共14 例胸壁惡性腫瘤的患者手術治療；包括直接侵及胸壁的肺腺癌、分化不良的肺類癌、肺肉瘤癌，原發性之胸壁惡性軟骨母細胞骨肉瘤、軟骨肉瘤、惡性纖維組織細胞瘤、漿細胞瘤、滑膜肉瘤，或續發性之胸壁惡性腫瘤，如直腸癌、舌癌、肝癌。手術方式包括胸壁切除、合併肺葉切除術、全肺切除手術、肺楔狀切除術、橫膈膜部分切除術、心包膜切除術、前上肢切除截肢手術。其他治療方法包括術前放射線加化學治療、手術前後放射線加化學治療、週波腫瘤燒灼術、動脈栓塞、及術後輔助性化學治療。14 例患者中有8 例做胸壁重建，使用的骨科鋼板1 至5 根。在這全數14 例患者術後皆不需要使用呼吸器。其中一位老年人因胃穿孔發生院內死亡。兩名病人因其他轉移病灶再次接受手術。平均術後存活時間約30.18 個月，3 年的存活率為76.4%。在一系列不同類型的胸壁惡性腫瘤，超過一半的患者腫瘤切除後需要骨科鋼板重建胸壁。胸壁之穩定可防止術後肺功能消減。積極手術對胸部低度惡性腫瘤可以得到比較好的預後。

The reconstruction of chest wall defects after resection of chest wall malignancies plays a critical role in postoperative chest care. The objective of this study is to describe patient selection for chest wall reconstruction using bone plates and to evaluate the surgical result of chest wall malignancies in a 3-year period. A total of 14 patients with chest wall malignancy were surgically treated. Malignancies including direct involvement of the chest wall by lung adenocarcinoma (n=3), lung sarcomatoid cancer, chondroblastic osteosarcoma, chondrosarcoma, malignant fibrohistocytoma, plamocytoma, synovial sarcoma, or secondary malignancy from rectal cancer, tongue cancer, and hepatoma (n=2) were examined in this study. Operative procedures consisted of chest wall resection combined with lobectomy (n=4), pneumonectomy (n=1), lung wedge resection (n=2), partial resection of diaphragm (n=3), pericardium (n=1), forequarter amputation (n=1). Other treatments included preoperative chemoradiotherapy (n=2), pre/postoperative chemoradiotherapy (n=1), postoperative chemoradiotherapy (n=1), radiofrequency ablation (n=1), arterial embolization (n=1), and postoperative adjuvant chemotherapy (n=4). Eight of 14 patients were selected for chest wall reconstruction using one to 5 bone plates for rib-spanning. None of the 14 patients required immediate postoperative ventilator support. One hospital death occurred in an elderly patient due to gastric perforation. Two patients underwent repeated surgeries for other metastatic lesions. The 3-year survival rate was 76.4% with a mean survival time of 30.18 months. In the series of patients with different types of chest wall malignancy, more than one half of the patients required chest wall reconstruction using bone plates after resection of chest wall malignancy. Chest wall stabilization can prevent postoperative impairment of respiratory function. Aggressive surgery of low grade chest malignancy can achieve good results.