外科手术治疗残留起搏导线导致的深部胸骨切口感染78例  

Surgical treatment of deep sternotomy infection caused by residual pacing lead:78 cases analysis

作　　者：崔振田 高永顺 Cui Zhentian;Gao Yongshun(Department of Cardiovascular Surgery,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心心血管外科,北京100700

出　　处：《中华胸心血管外科杂志》2020年第1期10-12,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨胸大肌肌瓣翻转手术治疗残留心外膜起搏导线导致的胸骨感染临床效果,总结治疗体会。方法回顾性分析2014年5月至2018年12月期间78例心脏手术后残留的心外膜起搏导线导致深部切口感染患者临床资料。其中男47例,女31例;年龄3~72岁。手术类型包括瓣膜手术38例(包括主动脉瓣成形术18例,主动脉瓣置换术9例,双瓣膜置换手术11例),冠状动脉旁路移植术14例,先天性心脏病手术26例(包括房间隔缺损修补术10例,室间隔缺损修补术11例,复杂畸形手术5例)。患者均因心脏起搏导线未完整拔除导致胸骨切口感染,采用胸大肌肌瓣翻转手术方式治疗。处理时间为开胸心脏术后15年32例,1年内46例。结果全组无死亡。伤口Ⅰ期愈合70例,Ⅱ期愈合5例,再次手术治疗后痊愈3例。随访71例患者1年,伤口感染均无复发。结论胸大肌肌瓣翻转手术治疗心脏术后残留心外膜起搏导线导致的胸部切口感染,治疗效果良好,值得临床推广。Objective To analysis and summarize the experience of surgical treatment of deep sternal infection caused by residual epicardial pacing.Methods Retrospective analysis of 78 patients with deep incision infection due to residual epicardial pacing lead after heart disease were selected from the Seventh Medical Center of PLA General Hospital from May 2014 to December 2018.Including 47 males and 31 females,aged 3-72 years old.38 patients with heart valve surgery(including 18 cases with aortic valvuloplasty,9 cases with aortic valve replacement,11 cases with double valve replacement),14 cases with coronary artery bypass grafting,26 cases with congenital heart disease surgery(10 cases with atrial septal defect repairment,11 cases with ventricular septal defect repairment,5 cases with complex malformation surgery).All patients were infected with sternal incision due to incomplete extraction of the cardiac pacing lead,and treated with the muscle flap turnover operation.The treatment time was 1-5 years after the cardiac surgery in 32 cases,and 46 cases in 1 year.Results There was no death in the study.70 cases were cured in stageⅠ,5 cases in stageⅡ,and 3 cases were cured after re-operation.71 cases were followed up for 1 year,there was no recurrence of wound infection.Conclusion The operation of pectoralis major muscle flap turnover has opened up a new approach for the treatment of thoracic incision infection caused by residual epicardial pacing lead after cardiac surgery,and it is worth popularizing in clinical practice.

关 键 词：心脏外科手术 深部胸骨感染 胸大肌肌瓣翻转术 

分 类 号：R65[医药卫生—外科学]