rib tumor resection

Benign tumors of the ribs have costal chondromas and osteochondromas, and the treatment only needs to remove the local ribs. Common chest wall malignancies include fibrosarcoma, chondrosarcoma, or malignant tumors that metastasize from other parts of the body to the ribs. A single chest wall malignant tumor, as long as there is no long-distance transfer, should be completely cut. In the primary or metastatic tumor of the rib, in addition to the removal of the ribs within 5 cm before and after the tumor, the intercostal muscles should be removed; if the lungs have been involved, partial pneumonectomy should also be performed. Treatment of diseases: chondromatosis osteoid osteoma Indication Benign tumors of the ribs have costal chondromas and osteochondromas, and the treatment only needs to remove the local ribs. Common chest wall malignancies include fibrosarcoma, chondrosarcoma, or malignant tumors that metastasize from other parts of the body to the ribs. A single chest wall malignant tumor, as long as there is no long-distance transfer, should be completely cut. In the primary or metastatic tumor of the rib, in addition to the removal of the ribs within 5 cm before and after the tumor, the intercostal muscles should be removed; if the lungs have been involved, partial pneumonectomy should also be performed. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation Preoperative chest fluoroscopy and radiography to find out whether the intercostal tumor and the lungs have adhesions. If necessary, use artificial pneumothorax to identify the chest and make a preparation for the chest. Surgical procedure Rib benign tumor resection 1. Position, incision: According to the tumor site, take the supine or lateral position. With the tumor as the center, the skin, subcutaneous tissue and muscle layer are cut along the ribs. Open the muscle layer and expose the ribs of the tumor. 2. Resection of the ribs: The rib periosteum of the tumor site is cut, and a transverse incision is made at each end of the periosteal incision so that the periosteum can be completely exfoliated. The periosteum was dissected with a periosteal stripper, and the ribs were removed under the periosteum, keeping the pleura intact [Fig. 1-1, 2]. 3. Stitching: After no bleeding, the chest wall muscles, subcutaneous tissue and skin were sutured intermittently with silk thread. Rib malignant tumor resection 1. Position, incision: the same as benign tumor resection. If the skin and muscle layers are already affected, the local skin and muscles should be removed together. 2. Open thoracic exploration: Incision of the intercostal muscle and pleura along the ribs near the base of the tumor, into the chest cavity, to explore whether the tumor is attached to the lungs. If there is no adhesion, only local tumors can be removed; if there is tumor involvement in the local lung, the incision should be enlarged for open thoracotomy. 3. Resection of the tumor: According to the extent of the tumor, the number and length of the resected ribs are determined, generally 5 cm beyond the edge of the tumor. The periosteum was cut at both ends of the rib segment to be resected, and the rib was cut off after a short period of time. The ribs were removed together with the periosteum and intercostal muscles, and then the blood was carefully stopped, and the cut intercostal blood vessels were sewed. If a pneumonectomy is required at the same time, the lung and the chest wall tumor should be removed together. 4. Repair of chest wall defect: The chest wall defect formed after tumor resection can be repaired by chest wall muscle, that is, after the drainage tube is placed in the midline of the lower thoracic cavity (8th to 9th intercostal space), the chest wall muscle near the incision is separated. The muscle flap is covered with the defect site and is sewn to the contralateral intercostal muscle or chest wall muscle of the incision. If the defect is large and the nearby muscle flap cannot be completely covered, it can be repaired with a fascia. The skin is sutured after suturing the skin. complication Wound infection.