1.2 Procedures 6 patients fire pot were under general anesthesia fire pot sternum extended resectio

Qiu Lin writer Kim Moon House

Sternal tumors are rare, accounting for 0.94% of all bone tumors [1], few reports in the literature [2], the complexity of its tissue of origin, pathological fire pot type variety, almost all malignant, with metastases, tumors of hematopoietic tissue and cartilage source fire pot category The most common tumors. Tumors of the sternum and relevant experience is not much care, surgical resection is the preferred method [3], mostly for extended resection, to restore the integrity of the thorax, in order to protect the heart and not to breathe affected, using a variety of methods Patch defects, such as autologous bone, allograft bone, steel, cement, glass, etc. [4-6]. biological material although no foreign body reaction, but there support is weak, drawn limited, complex surgical procedures fire pot and other shortcomings. The artificial material fire pot more than a foreign body reaction, vulnerability, not with the breathing fire pot exercise stretching and other shortcomings. Our department in February 2004 February 2007 for six cases of malignancy underwent sternum sternum extended resection of malignant tumors, with titanium mesh repair defects, results were satisfactory. Nursing are described below.
1.2 Procedures 6 patients fire pot were under general anesthesia fire pot sternum extended resection of malignant tumors, median sternotomy shuttle take-notch, from the sternal angle, down to the edge of the xiphoid, the free outer edge of the tumor, cut off bilateral pectoralis major in the sternum , costal cartilage and ribs on the starting point, to both sides of the free muscle flap, revealing tumors. Both sides of the rib cartilage surrounding the tumor and to cut free, at the corner sternum (second intercostal) or third intercostal transected sternum, fire pot free mediastinal tumor of the posterior wall of the adhesion, invasion fire pot and pericardium are part of the pericardial resection, near the xiphoid fire pot The tumor resection or even together at the sternum xiphoid partially transected Legong. Bilateral internal fire pot thoracic artery ligation handle various intercostal vessels. Two cases of thoracic drainage set the left and right pleural I suspect there is damage repair, four cases to the right set of closed thoracic drainage. Take the appropriate defect size titanium mesh inserted after pruning, combined with titanium screw titanium mesh wire fixation ribs and sternum stump at all, on both sides of the pectoralis major muscle to the midline suture covered titanium mesh, suture subcutaneous tissue and skin.
1.3 Results 4 patients had varying degrees of chest and cervical area subcutaneous emphysema, a few days after the disappearance; 1 case after the first two days contralateral pneumothorax, plus home thoracic drainage. 6 patients fire pot after 6-11 days of removal in thoracic drainage tube, the incision healed, including one case of pathology is no differentiation chondrosarcoma fire pot (no differentiation component of malignant fibrous histiocytoma), two weeks after discharge, refuse radiotherapy and chemotherapy, follow-up six months lost; than five cases were treated with chemotherapy and follow-up of one year, during treatment and follow-up of thoracic morphology were normal, no abnormal breathing, no loose or exposed titanium mesh.
Missionaries fire pot explain the importance of quitting smoking and respiratory function of patients and their families to exercise 2.1.2 preoperative and effective in patients with deep breathing and coughing church. The patient describes the surgical sites, the role of the surgeon, general surgery time, need to be placed in the drainage pipe and precautions, postoperative pain treatment before surgery to remove earrings, necklaces, dentures meaning, so that patients have adequate The mental preparation, but also conducive to postoperative fit. This group of patients before surgery six cases were quitting over two weeks, effective preoperative learn deep breathing and cough and expectoration.
2.2.2 Pain Care pain can lead to the whole body system fire pot adverse reactions, severe pain can increase blood pressure, agitation, irritability, fire pot due to pain patients are often afraid to cough and activities, to adversely affect postoperative recovery. Sympathy care patients, affable, fire pot listened carefully to the patient complained of pain in a timely manner to give comfort and handling. Keep quiet, soft lighting, give the patient was comfortable semi-recumbent, help stand up, all kinds of operations are gentle, avoid all bad pain stimuli. This group of six patients were using controlled intravenous analgesia pump, maintaining 48h, when used to inform patients and their families the right to use, maintain time and adverse reactions may occur. This group of patients pain well controlled.
2.2.3 prevent lung infections and hypoxemia due to anesthesia in patients after thoracotomy wound impaired lung function and chest pain in patients expectoration, can easily lead to atelectasis and lung infections, hypoxemia and carbon dioxide retention [7] should enhance the body before surgery surgery for tolerance, nurses teach patients to do before surgery reduced to blow up balloons lip breathing fire pot and exercise;. patient is asked to quit more than two weeks; choose the right lateral position, after 6h such as blood pressure stable giving the semi-recumbent position, so that the diaphragm down, increasing the chest capacity, increase gas exchange, help breathing; correct assessment of respiratory rate, rhythm and depth, monitoring oxygen saturation 1 / h, monitoring blood gas analysis fire pot 1 ~ 2 times / d, according to the results fire pot of blood gas analysis to adjust the oxygen flow; keep the airway open to prevent lung infections. Cough, expectoration is one effective way to prevent anesthesia basic pulmonary complications after thoracotomy. A day with or without abnormal auscultation, cough, fire pot expectoration and effective patient approach the church and to help patients, timed to assist turning knock back, chest to chest with a long, gently pressing the wound when you cough, so afraid of the pain the patient did not dare cough. Conventional oxygen inhalation twice daily. Sputum of patients in this group can be self-cough, lung infections fire pot and hypoxemia fire pot did not occur. fire pot
2.2.4 intraoperative fire pot bleeding and pneumothorax isolated tumor and pleural adhesions on both sides, has the potential to damage caused by pleural pneumothorax or subcutaneous emphysema, fire pot 4 patients in this group had varying degrees of postoperative chest and anterior subcutaneous area gas swollen, the performance of local swelling and anterior chest area, touch crepitus, one case of more severe cases to the 16th thick needle placed subcutaneously exhaust after symptoms disappear, lesser than three cases were not special treatment, subcutaneous emphysema self-absorbed, a few days after the disappearance. On both sides of thoracic intercostal arteries and blood vessels are not careful handling may cause bleeding, so close observation and an important factor in maintaining the patency of thoracic drainage is surgery to success. Meanwhile, the restoration of thoracic drainage negative pleural cavity and promote fire pot lung recruitment, is important to prevent fire pot complications [8]. Postoperative drainage tube properly fixed, to avoid distortions folded drainage tube to prevent drainage tube off. Intermittent Low to attract postoperative drainage, regular squeeze, to maintain its patency and observe the amount and nature of the fluid drainage, drainage volume in this group of six cases in the normal range, no active bleeding. The group 1 patients after the first two days contralateral pneumothorax, surgical injury may be added to the right side of the pleura and thoracic drainage set, after drainage healing, 6 patients after 6 ~ 11d in thoracic drainage tube removal.
2.2.6 titanium sternal fire pot infection prevention and bone tissue has to match the hardness and elasticity, easy shaping thin titanium mesh size and length can choose and cut demand, low density, high strength, non-allergenic, strong impact, easy cutting fire pot shaping, disinfection does not distort, does not affect fire pot the CT and MRI, etc. [10-11] Because titanium mesh mesh-like structure covered in easy-to-muscle, connective tissue fibers through the formation of granulation tissue, maintaining chest tightness restore the soft tissue, which is an important measure sternal defect success. The sternum will be used to repair the defect results were satisfactory, but if in the event of sternal infection is more serious consequences, because the sternum is important mediastinal organs, it is particularly important to prevent infection. Closely fire pot observed temperature changes every day, observe the incision with or without swelling, exudate, if exudate timely medication to keep the incision clean and dry, prophylactic use of antibiotics, while doing thoracic drainage tube care, keep the mouth clean and dry drainage tube, prevent drainage tube mouth, wound infection and the occurrence fire pot of heat duct, did not occur in this group of six cases of sternal infection, incision healed.
[6] Wang school, Chensi Yong, Wang Zhonghua, such as sternal reconstruction of thoracic tumor resection iliac bone graft case [J] Journal of Plastic Surgery, 2004, 20 (9): 400.
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