同种异体胸骨移植修复胸骨肿瘤切除后胸壁缺损

摘要

Objective To observe the result of allogeneic sternal transplantation repairing chest wall defect following resection of sternal tumors. Methods 21 patients with sternal tumors underwent partial or total sternal resection with deep frozen allogeneic sternum alternative for bony chest wall reconstruction, and a pectoralis major muscle flap, the right or left gastroepiploic artery pedicled greater omentum for reconstruction of soft tissue of chest wall. Immunoreaction of host was studied through detecting T- lymphocytes , complements and circulating immune complex (CIC) in peripheral fasting blood on 4th day preoperatively and 14th, 28th day postoperatively; healing status of allograft was evaluated by chest X-ray examination in 1,4,6,9,12,24,48 months and 99 m Te SPECT bone scan in 3 ,6,9 ,12,24,48 months after operation. Results The reconstructed chest were in good shape, no infection, no rejection, and respiratory motion was good. Only in 1 patient the wound healing delayed; There was no significant difference (all P>0.05) in T lymphocyte subgroup, serum C3, C4 and CIC in peripheral blood between pre- and post- operation. After 3 to 6 months of transplantation, SPECT bone scan displayed isotope concentration of allogeneic sternal ends and intramedullary were significantly lower than normal, and isotope concentration of autologous bone ends corresponding allogeneic sternal ends were significantly higher than that of normal. This phenomenon in 9 months after transplantation began to wane, up to several years. The chest X-ray showed the allogeneic sternal bone healing rate was 94. 7% . Conclusions Allogeneic sternal transplantation repairing chest wall defect following resection of sternal tumor not only ensure the thoracic integrity and stability, but also there are little rejection reaction and adverse reaction.%目的 观察同种异体胸骨移植修复胸骨肿瘤切除后胸壁缺损的效果.方法 对21例胸骨肿瘤患者行胸骨部分或全部切除,用经深低温冷冻处理后的同种异体胸骨重建骨性胸壁,用胸大肌肌瓣、胃网膜右或左动脉为蒂的大网膜重建胸壁软组织.分别于术前4d及术后14、28 d空腹抽取外周血,检测外周血T淋巴细胞亚群(CD4、CD8、CD3)及血清补体(C3、C4)和循环免疫复合物(CIC),观察宿主的免疫反应；分别于术后1、4、6、9、12、24、48个月行胸部X线检查,观察异体胸骨愈合情况；术后3、6、9、12、24、48个月行99mTe SPECT骨扫描,观察宿主的免疫反应及与异体骨的成活替代或吸收情况.结果 本组重建后胸廓外形良好,无感染,无排异反应,呼吸动度良好；仅1例皮肤愈合延迟.外周血T淋巴细胞亚群及血清C3、C4、CIC手术前后比较,P均＞0.05.胸部X线检查结果显示,异体胸骨愈合率为94.7％ (18/19).术后3～6个月SPECT骨扫描显示,移植的异体胸骨两端及髓腔内同位素浓集明显低于正常,而异体胸骨两端所对应的自体骨端同位素浓集明显高于正常；此现象于移植后9个月开始逐渐减弱.结论 采用同种异体胸骨移植修复胸骨肿瘤切除后胸壁缺损,不仅确保了胸廓的完整性与稳定性,且排异反应轻、不良反应少.