生物材料人工胸壁重建巨大胸壁缺损（附5例报告）.doc

生物材料人工胸壁重建巨大胸壁缺损(附5例报告)
作者:张兰军,李伟阳,苏晓东,谢泽明,龙浩,戎铁华,林鹏,郝崇礼,温浙盛,王军业
【摘要】目的: 应用生物材料人工胸壁重建巨大胸壁缺损,评估其临床应用的安全性及可行性. 方法: 以环氧交联多抗原簇封闭法及不同浓度氨基酸溶液漂洗法对猪的膜性及骨性材料进行组织处理及表面改性,制备出生物材料人工胸膜及人工肋骨,并于术中构建人工胸壁对5例巨大胸壁缺损的患者进行修复重建. 结果: 采用生物材料人工胸膜及人工肋骨对4例胸壁巨大缺损的患者进行重建;(14×11~21×18)cm,术后随访6~40 mo,均存活,且呼吸动度良好,无胸廓畸形及反常呼吸发生. 结论: 生物材料人工胸壁重建胸壁缺损符合生理结构,安全有效,是值得推广使用的胸壁重建方法.
【关键词】胸部损伤;人工胸壁;生物相容性材料;重建
【Abstract】AIM: To reconstruct the large chest wall defect with biomaterial artificial chest wall and to evaluate the clinical safety and feasibility of the biomaterial artificial chest wall. METHODS: We treated porcine tissue with an epoxy cross linking method, and modified the surface with amino acid solutions at various concentrations and at different temperatures to obtain a rectangular, flake
shaped material without antigenicity but with the flexibility and tensile strength of the original biomaterial. The artificial chest walls constructed in operation were used to repair the chest wall defect in 5 cases. RESULTS: Four cases of large chest wall defect were reconstructed with biomaterial artificial pleural and costal bone, and 1 case was reconstructed with autogeneic costal bone and Prolene Mesh. The defect area ranged from 21 cm×18 cm to 14 cm×11 cm. Within 640 months of followup, all patients survived with normal breath motion and no thoracic deformity. CONCLUSION: Using biomaterial artificial pleural and costal bone to reconstruct the chest wall defect is safe, feasible and effective. It is worthy to be widely applied.
【Keywords】 thoracic injuries; artificial chest wall; patible materials; reconstruction
0引言
由于胸部创伤及胸部肿瘤可导致胸壁的巨大缺损,当缺损面积大于5 cm×5 cm或有3根以上肋骨缺如时,会破坏胸壁骨性结构的稳定而导致严重的呼吸功能障碍,使患者面临严峻的生存危险,胸壁重建是解决这一棘手临床难题的关键. 目前国内外多采用高分子材料补片复合骨水泥或金属支架进行重建,但这种重建方式却因存在多种缺陷未能广泛采用[1-3]. 本研究采用环氧交联多抗原簇封闭法及不同浓度氨基酸液漂洗法对猪的膜性及骨性材料进行组织处理及表面改性,制备出生物材料人工胸膜及人工肋骨,并于术中构建成人工胸壁进行巨大胸壁缺损的修复重建,以评估其临床应用的安全性和可行性.
1对象和方法
05/200704我院收治胸壁巨大肿瘤患者(包括肺癌侵犯胸壁者)共5(男4,女1)例,年龄