胸主动脉置换后胸骨切口深部感染的外科治疗

The Surgical Treatment of Deep Sternal Wound Infections after Thoracic Aortic Prosthesis Graft

摘要: 目的：探讨胸主动脉置换后胸骨切口深部感染的手术治疗效果。方法：25例胸主动脉置换术后并发胸骨深部感染，男19例，女6例；年龄24~69岁。患者为主动脉夹层动脉瘤，行升主动脉及动脉弓置换，8例复合心瓣膜或冠脉手术。早期感染18例，后期7例。25例中有6例并发全身感染。切口适宜做负压引流装置(VSD)患者术前短期使用。手术方法：全麻下行胸骨伤口和纵膈感染手术治疗，以严格、彻底的清创操作流程，用胸大肌瓣内翻消除纵膈人工血管周围和切口残腔，用特殊方式缝合切口，使伤口内无异物存留。结果：25例胸主动脉置换并发胸骨切口深部感染，术后24例切口愈合(96.0%)；完全康复22例(88.0%)。后期升主动脉瘘1例，再手术治愈。2例因多器官衰竭和颅内迁徙性脓肿死亡；1例术后4月再现迁徙性脓肿病情恶化。结论：胸部大血管置换后伴胸骨深部感染的早期诊断和积极手术清除感染灶，切口I期愈合率高；总治愈率好。

Abstract: Object: To study surgical effects of deep sternal wound infections (DSWI) treated after thoracic aortic prosthesis graft (TAPG). Method: 25 patients were complicated with DSWI after TAPG, male 19 cases, female 6, age 24 - 69 y. The patients had aortic dissecting aneurysm, underwent ascending aorta and arterial arch replacement, and 8 patients underwent complex heart valve or coronary artery surgery. There were 18 patients with early DSWI, 7 with late. 6 cases of all pa-tients were complicating systemic infection. The incision is suitable for the short-term use of vacuum sealing drainage (VSD) in patients before surgery. Surgical Method: Under general an-esthesia, the sternal and mediastinal infection was debrided by the strict and thorough proce-dure flow sheet, and the dead space in the mediastinal was completely obliterated by the major muscle flaps to turn inward, by the special suture method without foreign matter remaining in the wound. Results: I stage wound healing by the surgery was in the 24 of 25 patients with DSWI after TAPG (96.0%). 22 patients completely recovered after the operation. The prosthesis as-cending aortic fistula was found for 1 patient during late surgery and healed by reoperation. 2 cases died respectively from multiple organ failure and migratory intracranial abscess. 1 case worsened from migratory abscesses 4 months after surgery. Conclusion: The patients with TAPG complicated DSWI diagnosed early and operated actively, had high wound healing rate, and better cure rate.