Surgical treatment of pleurocutaneous fistula in a patient 20 years after radiation therapy and breast-conserving surgery

Jovana Končar; Marijan Novaković; Dejan  Stojiljković; Marija  Raković; Vladimir  Jurišić; Sandra Radenković

doi:10.2298/VSP241211040K

Jovana Končar Institute for Oncology and Radiology of Serbia, Department of Surgery, Belgrade, Serbia
Marijan Novaković University Clinical Center of Serbia, Clinic for Plastic Surgery and Burns, Belgrade, Serbia
Dejan Stojiljković Institute for Oncology and Radiology of Serbia, Department of Surgery, of Radiation Oncology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Marija Raković Institute for Oncology and Radiology of Serbia, Department of Surgery, Belgrade, Serbia
Vladimir Jurišić University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
Sandra Radenković Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP241211040K

Ključne reči: dojka, neoplazme;, fistula;, radioterapija;, hirurgija, operativne procedure

Sažetak

Uvod. Radioterapija nakon poštedne operacije dojke smanjuje rizik od ponovnog lokalnog pojavljivanja bolesti i umereno smanjuje rizik od smrti izazvane rakom. Međutim, njeni dugoročni neželjeni efekti povezani su sa mnogobrojnim faktorima, uključujući starost bolesnika, komorbiditete, ukupnu dozu zračenja, veličinu frakcije, i stepen bolesti. Prikaz bolesnika. Prikazujemo bolesnicu staru 61 godinu koja je razvila ulceraciju u sredini postoperativnog ožiljka, praćenu progresivnom destrukcijom tkiva koja je na kraju dostigla veličinu 6 × 3 cm, što je rezultiralo ekspozicijom rebra. Pre dvadeset godina imala je poštednu operaciju desne dojke zbog invazivnog duktalnog karcinoma, sa postoperativnom terapijom zračenjem desnog zida grudnog koša i pripadajućih limfnih čvorova. Jednostavnu mastektomiju sa operativnim uklanjanjem svih sklerotičnih i kalcifikovanih tkiva, sa rekonstrukcijom desnog torakalnog zida, uradio je multidisciplinarni tim sačinjen od onkohiruga, torakalnog hirurga i plastičnog hirurga. Defekt desnog rebarnog luka 12 × 12 cm rekonstruisan je Mersilene^®mrežicom. Za rekonstrukciju defekta mekog tkiva podignut je i premešten „ostrvski“ muskulokutani latissimus dorsi režanj veličine 21 × 15 cm. Postavljeni su jedan torakalni dren i jedan dren za ranu. Postoperativni tok protekao je uredno i bolesnica je otpuštena 12. postoperativnog dana. Nije imala komplikacije nakon šestomesečnog praćenja. Zaključak. Kasne komplikacije terapije zračenjem su retke, ali su obično praćene teškim posledicama koje zahtevaju multidisciplinarni pristup u kompleksnom hirurškom lečenju.

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Hirurško lečenje bolesnice sa pleurokutanom fistulom 20 godina posle poštedne operacije dojke i zračne terapije

Sažetak

Reference