胸骨再固定治疗冠状动脉旁路移植术后胸骨哆开  

Sternal Resuturing Procedures for Sternal Dehiscence after Coronary Artery Bypass Grafting

作　　者：黄日茂[1] 罗万俊[1] 陈日[1] 杨扬[1] 陈旭良[1] 林国强[1] HUANG Ri-mao;LUO Wan-jun;CHEN Ri;YANG Yang;CHEN Xu-liang;LIN Guo-qiang(Department of Cardiac Surgery,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China)

机构地区：[1]中南大学湘雅医院心脏外科,长沙410008

出　　处：《中国现代手术学杂志》2018年第2期126-128,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨冠心病患者冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后胸骨哆开的原因、诊断、治疗及预防。方法 2010年1月~2016年6月我院共实施CABG 1 023例,术后14例发生胸骨哆开。采用回顾性分析研究患者的一般情况、发生病因、临床表现和诊断方法,以及病人确诊后的治疗方法和效果。结果 12例患者中,1例保守治疗治愈,11例再次手术行胸骨再固定术,术后8~10 d拆线,所有患者均治愈出院,术后平均住院时间(10.4±2.56)d。术后门诊随访3个月~6年,胸骨稳定,无并发症和死亡病例。结论胸骨哆开是CABG后的一种少见但严重的并发症,术中应用合理的缝合技术,术后防治并发症,积极治疗咳嗽等诱因,可减少胸骨哆开的发生。及时发现并处理胸骨松动以及适时的再固定处理,是治疗胸骨哆开和防止纵隔感染的关键。Objective To explore the causes of sternal dehiscence after coronary artery bypass grafting（ CABG）,and to discuss the methods for prevention,early diagnosis,and treatments. Method 14 cases suffered sternal dehiscence after CABG in our hospital between January,2010 and June,2016 were retrospectively studied. Results Of all 14 cases,13 cases accepted resuture procedures and one case accepted conservative treatments. All patients discharged with complete wound closure. Wound healing time was（ 10. 4 ± 2. 56） d.All patients were followed up for 3 months to 6 years after treatments,and no complications were found. Conclusion The sternal dehiscence after CABG is a rare but serious complication. The applications of proper techniques of suture,prevention and treatments of postoperative complications such as severe cough may be feasible methods to reduce the incidence of sternal dehiscence. Early sternal loosening detection and correction is the key to the treatment of sternal dehiscence and prevention of mediastinal infection.

关 键 词：冠状动脉旁路移植术 胸骨哆开 

分 类 号：R655.1[医药卫生—外科学] R654[医药卫生—临床医学]