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1 年 2 月第 1 5 卷第 2 期 DOI: /j.issn 累及胸壁的胸部肿瘤的外科治疗胸壁切除与重建 ( 附 12 例报告 ) 马少华申潞艳李森恺师晓天梁震陈克能临床经验摘要背景与目的胸部肿瘤累及胸壁是临床常见事件, 若无远处转移, 完整切除受累胸壁仍可获得良好疗效本文结合 12 例肿瘤患者胸壁切除与重建 (chest wall resection and reconstruction, CWRR) 的经验就重建人工材料软组织覆盖等方面作一介绍, 并强调切除外科与重建外科合作的重要性方法总结 2005 年 10 月年 4 月北京大学肿瘤医院胸外一科和重建外科共同参与的 CWRR 12 例, 详细复习自确诊至今的诊治全过程, 包括术前治疗手术方式切除范围重建方式, 主要的局部及全身并发症及生存情况结果 12 例均为根治性手术, 均行骨性胸壁切除, 切除后骨性胸壁缺损为 25 cm cm 2, 胸壁软组织缺损为 56 cm cm 2 骨性胸壁修补材料采用聚丙烯单丝网片 (polypropylene mesh), 软组织修复采用转移肌瓣转移肌皮瓣及大网膜瓣术后 1 例发生呼吸衰竭, 呼吸机辅助通气 1 个月后痊愈, 余 11 例均无并发症, 全组 12 例至今全部存活结论只有切除外科和重建外科同时参与才能完成符合肿瘤原则的复杂 CWRR 由切除外科主导重建外科协助了解并熟悉重建材料及胸壁软组织重建, 是达到手术根治性及保证远期生存的关键关键词胸部肿瘤 ; 胸壁 ; 切除 ; 整形中图分类号 R734.2 Chest Wall Resection and Reconstruction for Thoracic Tumor Invading the Chest Wall: A Report of 12 Cases Shaohua MA 1, Luyan SHEN 1, Senkai LI 2, Xiaotian SHI 3, Zhen LIANG 1, Keneng CHEN 1 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery I, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing , China; 2 Plastic Surgery Hospital (Institute), Peking Union Medical College, Beijing , China; 3 Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang , China Corresponding author: Keneng CHEN, chenkeneng@yahoo.com.cn Abstract Background and objective Tumor involving the chest wall is a common clinical event, and if there are no distant metastases, complete resection of tumor and involved chest wall can give excellent results. The aim of this study is to report experience with chest wall resection and reconstruction (CWRR) for 12 patients who suffered thoracic malignant tumor involving chest wall, including the artificial materials used for reconstruction, soft tissue coverage, and our multidisciplinary CWRR approach. Methods All characteristics of 12 cases of CWRR from Oct 2005 to Apr 2011 were reviewed, including preoperative treatment, surgical approach, resection range, reconstruction methods, the local and systematic complications and postoperative survival. Results All 12 of these patients underwent radical resection and bony chest wall resection, with resultant bony chest wall defects ranging from 25 cm 2 to 700 cm 2, soft tissue defects of 56 cm 2 to 400 cm 2. The bony chest wall was reconstructed using polypropylene mesh, and repair of the soft tissue was carried out using the shifting muscle flaps, myocutaneous flaps and omental flaps. There was only one significant complication in these 12 cases where 1 case suffered respiratory failure and needed mechanical ventilation but recovered one month later. All 12 patients have survived to the end point of follow up. Conclusion Only thoracic surgery and reconstructive surgery work together can complete the complex CWRR which according the tumor discipline. Thoracic surgeons as the leader and reconstructive surgeons as the subsidiary and be familiar 本研究受北京市卫生系统高层次卫生技术人才培养计划 ( ) 北京市自然科学基金项目( ) 首都医学发展科研基金 ( ) 教育部博士生学术新人奖和国家 973 计划 (.2011CB504300) 资助作者单位 : 北京, 北京大学肿瘤医院暨恶性肿瘤发病机制及转化研究教育部重点实验室胸外一科 ( 马少华, 申潞艳, 梁震, 陈克能 ); 北京, 中国医学科学院整形外科医院 ( 李森恺 ); 安阳, 安阳肿瘤医院胸外科 ( 师晓天 )( 通讯作者 : 陈克能, chenkeneng@yahoo.com.cn)

2 年 2 月第 1 5 卷第 2 期 91 with reconstruction materials of bony chest wall and appropriate choice of soft tissue coverage is the key to achieve radical surgery and to ensure long-term survival. Key words Thoracic neoplasms; Thoracic wall; Resection; Reconstruction This study was supported by the grants from Beijing Academic Leaders Program ( ), Beijing Natural Science Foundation ( ), Capital Medical Development Research Found ( ), New Scholar Star Program of Ministry of Education, and National Basic Research Program of China (973 Program)(.2011CB504300)(all to Keneng CHEN). 胸壁原发性肿瘤和胸部肿瘤侵犯胸壁是胸外科常见的临床情况, 需行胸壁切除, 对胸外科医生来讲切除胸壁并非难事然而, 胸壁的完整性是维持人体正常呼吸循环生理解剖的重要组成部分, 切除后联合整形外科, 需选用合适的人工材料重建胸壁以恢复其解剖和生理, 并选用合适的软组织覆盖以保护人工材料以便最终愈合, 从而达到根治肿瘤, 改善疗效的目的现将北京大学肿瘤医院的 12 例胸壁切除与重建 (chest wall resection and reconstruction, CWRR) 治疗经验总结如下 1 患者与方法 2005 年 10 月年 4 月北京大学肿瘤医院胸外一科和重建外科共同参与的 CWRR 12 例 ( 表 1), 其中男性 8 例, 女性 4 例, 年龄 37 岁 -78 岁, 包括左侧胸壁软骨肉瘤术后复发侵犯第肋骨, 前锯肌, 左肺下叶, 心包及膈肌 1 例 ; 右乳腺癌术后放疗局部皮肤破溃 30 年, 恶变为疣状癌, 侵犯双侧第肋软骨, 部分胸骨, 右侧胸大肌及心包 1 例 ; 左胸壁恶性纤维细胞瘤术后复发, 侵犯前锯肌及左第肋骨 1 例 ; 右肺上叶腺癌侵犯右前第 3 4 肋骨及前锯肌 1 例 ; 左乳腺癌术后 3.5 年局部胸壁复发侵犯左胸大肌, 胸小肌, 左第肋软肋骨及左侧部分胸骨 1 例 ; 前纵隔鳞癌术后复发侵犯右侧第 4 5 前肋, 右侧部分胸骨, 胸小肌及胸大肌 1 例 ; 左肺上叶癌术后 8 个月, 局部胸壁复发, 侵犯左第 3 4 肋骨及前锯肌 1 例 ; 胸壁孤立性转移癌侵犯左后第 8 肋骨, 前锯肌及下后锯肌 1 例 ; 左肺上叶腺癌侵犯第 1 2 前肋及胸小肌 1 例 ; 右肺上叶鳞癌侵犯右前第 2 肋骨及胸小肌 1 例 ; 左肺上叶腺癌侵犯左第 4 后肋 1 例 ; 前纵隔弥漫大 B 细胞淋巴瘤侵犯左侧第 4 5 肋骨及下 1/2 胸骨 1 例 1 2 例患者术前均行胸部增强计算机断层显像 (computerized tomography, CT) 检查,2011 年以前手术的 7 例患者均行常规分期检查, 如颈部及腹部超声骨扫描头颅核磁等,2011 年手术的 5 例患者除常规分期检查外, 加行正电子发射计算机断层显像 (positron emission tomography-computerized tomography, PET-CT) 检查, 其中 1 例在 2 周期新辅助化疗后复查 PET-CT 术前对心肺功能做详细评估, 包括心脏彩超肺功能及动脉血气分析所有患者术前均与整形外科医生会诊, 设计切口, 骨性胸壁及软组织切除范围及软组织修补方式 2 结果 2011 年以前手术的 7 例患者术前常规肿瘤分期检查均未见远处转移及肿瘤淋巴引流区域明显肿大淋巴结 2011 年手术的 5 例患者除常规分期检查外加行 PET-CT 检查, 除肿瘤本身外均未见全身其它部位及肿瘤淋巴引流区域高代谢病灶 12 例术后病理均证实无引流区域淋巴结转移 5 例行 PET-CT 检查中的 1 例患肺癌者行新辅助化疗, 在化疗后复查 PET-CT, 其标准摄取值 (standard uptake value, SUV) 明显下降, 且此 5 例术前均加做了 CT 三围胸壁骨成像 ( 图 1), 明确显示了骨性胸壁受累情况, 与术后病理结果吻合 12 例均行根治性切除 ( 表 2) 肿瘤直径 25 mm 25 mm-250 mm 280 mm, 其中 1 例肿瘤导致皮损面积达 200 mm 200 mm( 图 2) 所有切口均根据肿瘤生长部位及范围来决定, 均为不规则切口, 切口总长度从 15 cm-90 cm 不等 ( 图 2) 切除后胸壁软组织缺损 56 cm cm 2 ; 同时切除骨性胸壁 12 例, 骨性胸壁缺损 25 cm cm 2, 骨性胸壁修补材料采用聚丙烯单丝网片 ( 图 3), 软组织修复采用转移肌瓣转移肌皮瓣或大网膜转移瓣, 其中胸大肌转移肌瓣 4 例 ( 图 3), 背阔肌转移肌瓣 3 例 ( 图 4), 胸大肌及背阔肌联合转移肌瓣 1 例, 腹直肌肌皮瓣 1 例 ( 图 5), 大网膜转移瓣 1 例 ( 图 6) 1 例由于为感染切口未行人工材料修补, 而采用了广泛游离的皮瓣修复 ( 图 2) 其修复方法为以肿瘤为中心的 X 形切口, 皮瓣游离范围上达双侧锁骨水平, 下达髂前上棘, 外侧达双侧腋后线, 此例术后呼吸衰竭 ( 限制性通气障碍 ), 呼吸机辅助通气 1 个月后痊愈全组中另有 1 例系后胸壁切除, 有肩胛骨覆盖且未累及胸部软组织而只切除胸壁未作真正意义上

3 年 2 月第 1 5 卷第 2 期图 1 病例 10, 男性,74 岁, 右肺上叶癌, 侵犯右第 2 前肋及胸小肌, 实施新辅助化疗 2 周期后手术术前 CT 三位骨重建明确显示右第 2 前肋受累, 与化疗前 PET 比较, 局部病灶最大 SUV 值由 10.8 降至 7.7 Fig 1 Case 10, 74-year old male, with lung cancer of right upper lobe invading 2 nd rib and pectoralis minor muscle. Treated with 2 cycles of neo-adjuvant chemotherapy followed by surgery. Threedimensional CT synthetic image shows tumor invading 2 nd rib, compare with the first PET/CT prior to chemotherapy (top right). SUV decreased from 10.8 to 7.7. SUV: standard uptake value. 图 2 病例 2, 女性,76 岁,30 年前行右乳腺癌改良根治术, 术后放疗致皮肤溃疡经久不愈, 切除肿瘤 80 mm 50 mm, 骨性胸壁缺损为 100 mm 80 mm, 皮损面积达到 200 mm 200 mm, 因感染, 未行人工材料修补, 仅广泛游离左侧乳腺及上腹部皮瓣修补软组织 Fig 2 Case 2, 76-year old female, underwent radical mastectomy followed by radiotherapy. Local skin ulcer prolong for 30 years. She underwent CWRR, and the tumor was 80 mm 50 mm, the defect of bony chest wall was 100 mm 80 mm, and the soft tissue defect reached to 200 mm 200 mm. Due to infection, synthetic materials were not used, widely dissociative skin flaps were used to repair the large chest wall defect. 图 3 病例 10, 男性,74 岁, 右肺上叶癌, 侵犯右第 2 前肋及胸小肌, 实施新辅助化疗 2 周期后, 实施右肺上叶 + 第部分肋骨 + 部分胸小肌切除, 骨性胸壁缺损达 100 mm 100 mm, 采用聚丙烯单丝网片修补, 软组织修复采用胸大肌转移肌瓣 Fig 3 Case 10, 74-year old male Lung cancer of right upper lobe, with invasion of 2 nd rib and pectoralis minor muscle. Treated with 2 cycles of neo-adjuvant chemotherapy followed by surgery consisting of right upper lobectomy, the 1 st, 2 nd and 3 rd ribs and partial pectoralis minor muscle resection. The bony chest wall defect was 100 mm 100 mm, and polypropylene mesh was used for reconstruction and the synthetic material was covered by pectoralis major muscle flap.

4 年 2 月第 1 5 卷第 2 期 93 图 4 病例 8, 男性,53 岁, 左后胸壁单发肿瘤, 侵犯左后第 8 肋骨, 实施左后第肋骨部分切除, 切除后骨性胸壁缺损 100 mm 65 mm, 采用聚丙烯单丝重建骨性胸壁, 背阔肌转移肌瓣修补软组织 Fig 4 Case 8, 53-year old male, isolated left chest wall metastasis involving the posterior left 8 th rib, underwent CWRR with resection of left 7 th, 8 th, and 9 th ribs. The bony chest wall defect was 100 mm 65 mm, and polypropylene mesh was used for to reconstruction, which was covered with latissimus dorsi muscle flap. 图 5 病例 6, 男性,78 岁, 前纵隔鳞癌术后复发, 侵犯右第 4 5 肋骨右侧部分胸骨胸小肌及胸大肌, 实施右第前肋右侧部分胸骨部分胸小肌及部分胸大肌切除, 骨性胸壁缺损 140 mm 120 mm, 软组织缺损 200 mm 150 mm, 采用左侧腹直肌转移肌瓣修复胸壁软组织缺损 Fig 5 Case 6, 78-year old male, Anterior mediastinal postoperative recurrence of squamous cell carcinoma, which involved the right 4 th and 5 th ribs, part of the sternum, and the pectoralis minor and major muscles. Treated with CWRR, with resection of the right 3 rd, 4 th, 5 th and 6 th ribs, partial sternal resection, and partial resection of the pectoralis minor and major muscles. The bony chest wall defect measured 140 mm 120 mm, with a soft tissue defect of 200 mm 150 mm. Polypropylene mesh was used to repair the chest wall defect and a left rectus muscle flap was transferred to cover the artificial material. 图 6 病例 12, 男性,39 岁, 前纵隔弥漫大 B 细胞淋巴瘤, 侵犯第 4 5 肋骨 + 左侧部分胸骨, 实施双侧肋软骨切除 + 部分胸骨切除 + 左肺上叶切除, 骨性缺损 120 mm 80 mm, 采用聚丙烯单丝修补, 软组织缺损达 150 mm 100 mm, 采用大网膜转移瓣修补 Fig 6 Case 12, 39-year old male, with lymphoma of the anterior mediastinum involving the 4 th and 5 th ribs and part of the sternum. Treated with bilateral 3 rd, 4 th, 5 th and 6 th costal cartilage resection, partial sternal resection and resection of the left upper lung lobe. The bony chest wall defect measured 120 mm 80 mm and soft tissue defect measured 150 mm 100 mm. Polypropylene mesh was used to repair the bony defect followed by use of a greater omental flap to cover the artificial material.

5 年 2 月第 1 5 卷第 2 期表 1 12 例胸壁切除与重建患者一般资料 Tab 1 General data of 12 patients with CWRR. Gender Age Diagnosis Tumor diameter (mm) Bony chest wall invading Soft tissue invading Neo-adjuvant chemo Adjuvant chemo 1 Male 68 Chondrosarcoma recurrence of left chest wall 2 Female 76 Local skin ulceration malignant transform to verrucous carcinoma after mastectomy 3 Female 37 Recurrence malignant fiber cell tumor of left chest wall 4 Male 73 Adenocarcinoma of left upper lobe lung th, 7 th, 8 th rib Serratus anterior Bilateral 2 nd, 3 rd, 4 th, 5 th costal cartilage and partial of stemum Pectoralis major th, 5 th, 6 th rib Serratus anterior rd, 4 th rib Serratus anterior TP 4 5 Female 53 Local recurrence of left chest wall after radical mastectomy nd, 3 rd, 4 th rib and partial of sternum Pectoralis major, pectoralis minor 6 Male 78 Anterior mediastinal recurrence squamous cell carcinoma th, 5 th rib and right partial sternum Pectoralis major, pectoralis minor TP 3 7 Male 60 Recurrence squamous cell carcinoma after pulmonary lobectomy of left upper lobe rd, 4 th rib Serratus anterior 8 Male 53 Isolation metastatic carcinoma of left chest wall th posterior rib Serratus anterior and serratus posterior inferior muscle TP 2 9 Male 53 Adenocarcinoma of left upper lobe lung st, 2 nd anterior rib Pectoralis minor muscle TP 1 10 Male 74 Squamous cell carcinoma of right upper lobe lung nd anterior rib Pectoralis minor muscle TP 2 11 Female 56 Adenocarcinoma of left upper lobe lung th posterior rib TP 2 TP 2 12 Male 39 Diffuse large B-cell lymphoma of anterior mediastinal Left 4 th, 5 th rib and partial of stenum CWRR: chest wall resection and reconstruction; Chemo: chemotherapy 的修复 12 例患者随访至 2011 年 5 月 15 日, 全部存活, 其中 1 例左侧胸壁恶性纤维细胞瘤行 CWRR 术后 43 个月发生肺转移, 再行肺叶部分切除术 3 讨论 3.1 肿瘤根治原则是胸壁切除术的前提胸壁切除与重建的创伤较大, 除少数情况以外, 保证根治性原则使患者生存获益是该治疗的前提胸部肿瘤需胸壁切除的情况包括 : 原发性胸壁骨软组织肿瘤, 相邻部位肿瘤侵犯复发及遗留的创伤并发症, 如溃疡坏死等, 孤立的胸壁转移这一工作主要由胸外科医生完成, 包括对原发疾病分期的评估, 胸壁切除的范围与硬性胸壁重建的设 [1] 计等, 其中以实施全面分期检查尤为重要文献报道肺癌累及胸壁行 CWRR 后,N0 患者术后 5 年生存率明显高于 N1/N2 患者, 分别为 39.2% 和 7.1% 乳腺癌侵犯胸壁行 CWRR 后的 5 年生存率为 39.2%, 而复发性乳腺癌行 CWRR 后中位生存时间可达 36 个月 [2] 本组 2011 年以前手术的 7 例患者, 术后病理证实均未见淋巴结转移, 术后均存活, 最长 1 例已存活 66 个月常用的术前影像学分期方法以 CT 核磁共振等为主, 值得一提的是, 近年来以 PET-CT 为主要代表的功能影像学的常规应用更为重要 [3] 2011 年手术的 5 例患者除传统的分期检查外, 均采用了 PET-CT 检查,5 例患者除局部病灶外均未发现远处转移及淋巴结转移, 而且与术后病理结果一致其中的第 10 例患者新辅助化疗 2 周期后复查 PET-CT 提示 SUV 值降低, 肿瘤明显缩小, 更为术后的辅助化疗提供了良好的依据 3.2 骨性胸壁的重建是恢复心肺功能的保证对呼吸功能较好, 切除范围较小者,CWRR 对呼吸的机械影响可忽略不计, 若以软组织瓣覆盖也可在一定程度上克服术后胸壁的反常呼吸 [4-7] 但对缺损较大者需行骨性胸壁重建国内尝试过多种稳定性材料, 包括自体和人工材料两类, 前者因为额外增加手术切口而被淘汰人工材料如不锈钢钛合金透明树酯玻璃纤维等硬材料难以避免腐蚀感染, 也很少应用 [8] [9] 即便近年来国内的文献

6 年 2 月第 1 5 卷第 2 期 95 表 2 12 例胸壁切除及成形患者手术情况 Tab 2 Operation features of 12 patients treated with CWRR. Organs resection Defect of bony chest wall (mm) Defect of soft tissue (mm) Material of bony chest wall reconstruction Coverage Operation time Survival time (month) 1 Partial of left lower lobe, partial of pericardium, partial of diaphragm, 6 th, 7 th and 8 th rib 2 Bilateral 2 nd, 3 rd, 4 th, 5 th costal cartilage, partial of sternum, partial of left upper lobe, partial of pericardium 3 Left 4 th, 5 th, 6 th rib, partial of left lower lobe Marlex Left latissimus dorsi musclar flap Widely dissociative skin flaps Marlex Left latissimus dorsi muscle Right upper lobe of lung, 3 rd, 4 th rib, partial of serratus anterior muscle Polypropylene Right pectoralis major muscle flap Left 2 nd, 3 rd, 4 th costal cartilage, partial left sternum Polypropylene Right pectoralis major muscle flap Right 3 rd, 4 th, 5 th, 6 th rib, partial of right sternum 7 Left 2 nd, 3 rd, 4 th, 5 th rib, partial of serratus anterior muscle 8 Left 7 th, 8 th, 9 th rib, partial of serratus anterior muscle, partial of serratus posterior inferior muscle 9 Left upper lobe of lung, 1 st, 2 nd, 3 rd rib, partial pectoralis minor muscle Polypropylene Polypropylene Polypropylene Polypropylene Left rectus abdominis muscleflap Left pectoralis major muscle flap and latissimus dorsi flap Latissimus dorsi flap Pectoralis major muscle flap Right upper lobe of lung, 1 st, 2 nd, 3 rd rib, partial pectoralis minor muscle Polypropylene Pectoralis major muscle flap Left upper lobe of lung, 4 th, 5 th rib Scapula Left upper lobe of lung, 3 rd, 4 th, 5 th Polypropylene Great omental flap rib, partial of sternum 报道胸壁重建材料为有机玻璃板玻璃条钢丝网钛板涤纶硅橡胶等, 但也因为修补材料与组织结合困难, 后期常常松动造成组织破坏而逐渐被淘汰目前, 良好的骨性胸壁重建材料需要具备以下几个条件 [9] :1 柔软易放置, 顺应性好, 且能维持胸壁的强度及美观 ; 2 组织反应性小, 与组织能够完全融合 ;3 感染风险较低 ;4 机械强度高, 以便能够维持很长时间 ;5 能够成为潜在早期复发者手术切除的标记近年流行的 Marlex 网 polypropylene 网等网状材料, 其特点为多孔网状, 可与组织融合, 且融合后顺应性好, 更适合胸壁重建 [7,10] 本组全部选用聚丙烯单丝网状补片, 组织相容性好, 顺应性强且维持了一定的胸壁硬度 3.3 术前与整形外科的会诊, 多学科会诊是治疗成功的关键后外侧切口, 前外侧切口及正中切口是胸部手术常用和孰知的切口, 这不但有利于保护胸壁软组织, 减少创伤, 也便于肋间进胸, 可完成绝大多数的胸内操作, 因而为广大的胸外科医生熟知和广泛接受但胸壁切除与重建往往需要联合切口, 甚至是依肿瘤的生长选择不规则切口, 因而术前需要与整形外科医生会诊, 会诊的目的在于外科医生与整形外科医生共同商议切除范围, 切口的难易程度等, 从而便于设计修复途径, 使胸外科医生了解首选次选和最后的修复设计, 了解各个皮瓣的血运来源, 从而达到最大程度的根治性以保证疗效, 最好保留重建肌皮瓣的血运以达到最好的修补效果 CWRR 手术要点为骨性胸壁修复及肌瓣 / 肌皮瓣的转移及应用应用网状补片材料修补骨性缺损后, 需要适当的软组织覆盖, 防止皮肤坏死, 整形外科医生在其中有重要的作用, 如本组第 2 例患者系乳腺癌改良根治术后放疗致皮肤溃疡经久不愈就诊, 因感染胸壁切除后不宜使用人工材料修复, 但仍然要维持胸壁的硬度, 则需要更厚的软组织皮瓣来修补, 遂采用右侧腹直肌及对侧胸大肌联合肌瓣, 肌瓣外再以对侧乳腺组织覆盖以完成修复总之, 胸壁切除与重建在胸部肿瘤有广泛的应用途

7 年 2 月第 1 5 卷第 2 期径, 熟知切除的生存获益使广大胸壁受累的患者获得了根治机会, 熟知重建材料肌瓣的进展也为更多的患者提供了治愈的机会参考文献 1 Lin YT, Hsu PK, Hsu HS, et al. En Bloc resection for lung cancer with chest wall invasion. J Chin Med Assoc, 2006, 69(4): Chen KN, Yu P. Significance of multidisplinary surgery in chest wall resection and reconstruction for selected patients with breast cancer. Zhong Hua Zhong Liu Za Zhi, 2006, 28(11): [ 陈克能, Peirong Yu. 外科多专业合作胸壁切除与重建术在乳腺癌侵犯胸壁患者治疗中的地位. 中华肿瘤杂志, 2006, 28(11): ] 3 Lardinois D, Weder W, Hany TF, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computer tomography. N Engl J Med, 2003, 348(25): Chang RR, Mehrara BJ, Hu QY, et al. Reconstruction of complex oncology chest wall defects: a 10-year experience. Ann Plast Surg, 2004, 52(5): Amold PG, Pairolero PC. Chest-wall reconstruction: an account of 500 consecutive patients. Plast Reconstr Surg, 1996, 98(5): Tukiainen E, Popov P, Asko-Seljavaara S. Microvascular reconstruction of full-thickness oncological chest wall defects. Ann Surg, 2003, 238(6): Mansour KA, Thourani VH, Losken A, et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg, 2002, 73(6): Chen KN, Yu P. Chest wall resection and reconstruction. Zhong Hua Wai Ke Za Zhi, 2005, 43(14): [ 陈克能, Peirong Yu. 胸壁切除及其重建. 中华外科杂志, 2005, 43(14): ] 9 Rocco G. Overview on current and future chest wall reconstruction. Thorac Surg Clin, 2010, 20(4): Mao NQ, Zuo CT, Zhou YM, et al. surgical treatment of chest wall tumor. Zhong Guo Xiong Xin Wai Ke Lin Chuang Za Zhi, 2005, 12(4): [ 茅乃权, 左传田, 周元明, 等. 胸壁肿瘤的外科治疗. 中国胸心外科临床杂志, 2005, 12(4): ] ( 收稿 : 修回 : ) ( 本文编辑孙丹 ) 消息第七届中国肿瘤学术大会会议通知由中国抗癌协会中华医学会肿瘤学分会共同主办, 国际抗癌联盟 (UICC) 美国临床肿瘤学会 (ASCO) 协办, 首都医科大学首都医科大学附属北京世纪坛医首都医科大学肿瘤医学院首都医科大学肿瘤学系承办的第七届中国肿瘤学术大会暨第十一届海峡两岸肿瘤学术会议将于 2012 年 9 月 6 日 -9 日在北京隆重召开会议时间 :2012 年 9 月 6 日 -9 日会议地点 : 中国北京联系地址 : 北京市海淀区羊坊店铁医路 10 号 (100038) 首都医科大学附属北京世纪坛医院教育处

分级和气管是否受侵是影响预后的独立危险因素关键词状腺肿瘤 ; 癌, 乳头状 ; 预后 Clinical outcomes of 600 papillary thyroid carcinoma patients ZHANG Zong-min,

分级和气管是否受侵是影响预后的独立危险因素关键词状腺肿瘤 ; 癌, 乳头状 ; 预后 Clinical outcomes of 600 papillary thyroid carcinoma patients ZHANG Zong-min, 移性鳞癌患者的临床资料, 比较不同治疗手段的效果 50 例患者男性 44 例, 女性 6 例, 年龄 29~73 岁, 中位年龄 52.5 岁 ; 临床分期 :N2c 占 64% (32/50),N3 占 36% (18/50) 30 例患者行双颈淋巴结清扫术 50 例患者均行放疗, 剂量为 50~66