心脏术后深部胸骨伤口感染的外科处理

目的探讨胸骨正中切口心脏术后深部胸骨伤口感染的外科治疗策略。方法采用回顾性调查方法 ,选择中国医学科学院北京协和医院2003年1月~2014年7月入院经胸骨切开心脏术后发生深部胸骨伤口感染的患者为研究对象,对深部胸骨伤口感染的特点及治疗措施进行分析。结果 2936例患者中28例出现深部胸骨伤口感染,感染率为0.95%,术后感染发生于术后第7天~12个月,术后1个月内发生感染24例,术后14 d内发生感染22例。28例感染患者中,8例患者应用了闭式负压吸引技术;12例接受了保留胸骨再固定胸骨术;4例切除部分胸骨再固定胸骨术;2例彻底清创胸骨、胸大肌肌瓣移植术;7例彻底清创胸骨、腹直肌肌皮瓣移植术;3例未手术治疗。28例感染患者中,死亡5例,其余无感染复发,均恢复正常生活或工作。结论首选保留胸骨再固定术可作为治疗深部胸骨伤口感染的基本原则,对于胸骨感染高风险的患者,胸骨切除及组织瓣移植术是一种有效的治疗手段。

Surgical treatment of deep sternal wound infection after cardiac surgery

Objective To investigate surgical strategies to deep sternal wound infection（DSWI） after cardiac surgery via median sternotomy. Methods A retrospective study on the patients who underwent DSWI after cardiac surgical procedures during the period from January 2003 to July 2014 in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. The characters of the DWSI and treatment were analyzed. Results Among 2936 patients, 28 patients was diagnosed with postoperative deep sternal infection. The overall incidence of postoperative DWSI was0.95%. DWSI occurred postoperatively 7 d to 12 months. 24 patients underwent DWSI within 1 month after cardiac surgery. 22 patients underwent DWSI occurred within 14 days postoperatively. Among 28 patients with DWSI, 8 patients underwent vacuum-assisted closure therapy; 12 patients were given preservation of sternum and sternal refixation; 4 patients were given partial sternal resection and sternal refixation; 2 patients were given radical sternal debridement and the pectoralis major flap; 7 patients were given radical sternal debridement and the rectus abdominis musculocutaneous flap; 3 patients were no operation. 5 cases of the 28 patients with DWSI were death. No recurrence of infection was appeared, the rest were all back to normal life or work. Conclusion The sternal preservation can be the principal aim of surgical management in patients with DWSI. Radical sternectomy and tissue flap reconstruction is a therapeutic option for high-risk patients, providing a safe, effective control of the infection.