心脏换瓣术后胸壁瘘及慢性化脓性肋软骨炎的处理策略

目的：探讨开胸心脏瓣膜替换术后胸壁瘘及慢性化脓性肋软骨炎的处理方法。方法：对单根的肋软骨炎并胸壁瘘者,在压痛最明显处直接切除受累的肋软骨及窦道组织;对伴瘘的胸部多根肋软骨炎,可在经胸壁相对正常处切开,建立以远离感染部位为蒂的开放胸部皮瓣,经瘘口加压注入美蓝使受累的肋软骨及坏死筋膜染色,沿染色部完整切除受累的肋软骨及筋膜、瘘管周围组织;在手术创面皮瓣下置放盆式多孔引流管,术后持续低负压吸引,选用敏感抗生素。结果：本组3例,术后6天拨管,10天后伤口愈合,效果良好。结论：经正常皮肤切口入路,建立开放胸壁皮瓣,彻底清除感染坏死的肋软骨及瘘管周围组织是治疗开胸心脏换瓣术后胸壁瘘及慢性化脓性肋软骨炎的可靠方法。

Treatment for the Fistula of Chest Wall and Chronic Suppurative Costochondritis following Heart Valve-Replaced Operation

Objective： To probe into the treatment for fistula of chest wall and chronic suppurative costochondritis following cardiac valve replacement.Methods： The patients with single costochondritis complicated with fistula of chest wall,received removal of costal cartilage and fistular fasciae.The patients with multiple costochondritis complicated with fistula of chest wall were dissected at the normal site and formed an open skin flap with a pedicle away from infected site.Methylene blue was injected through the entrance of the fistula in order to dye the involved costal cartilages and necrotic fasciae.The involved costal cartilages,necrotic fasciae and the tissues around the fistula tube were removed along the dye.A multiple drainage tube was placed under the skin slap at the surgical wound with persistent low negative pressure.The sensitive antibiotics were administered.Results： A total of three cases were collected in the group.All the patients undertook extraction of the drainage tube on the sixth day after operation.The surgical wounds healed 10 days after surgery with good effects.Conclusion： It is reliable to dissect at the normal site so as to form an open skin flap on chest wall and completely take out the necrotic costal cartilages and tissues around fistula tube in the treatment for fistula of chest wall and chronic suppurative costochondritis following open cardiac valve replacement.