抗菌薇乔线用于正中开胸术后深部胸骨伤口感染的修复疗效

Effect of Antibacterial Vicryl Suture Closure for Reconstruction of Deep Sternal Wound Infection Defects after Median Sternotomy

目的 观察11例正中开胸术后深部胸骨伤口感染(deep sternal wound infection,DSWI)的患者,在彻底清创后使用抗菌薇乔线闭合胸骨的疗效。方法 收集2016年12月至2019年3月在广东省人民医院使用抗菌薇乔线闭合胸骨以修复DSWI的患者共11例的临床资料,包括患者的年龄、性别、发病时间、住院时间、手术持续时间及术中出血量。术后常规对患者进行随访。结果 患者的年龄范围为44~76岁(男8例,女3例),根据胸骨计算机断层扫描(computed tomography,CT)的表现,所有患者均确诊为DSWI。经过彻底清创,联合负压封闭治疗1周后,所有患者均采用抗菌薇乔线将胸骨闭合修复,所有患者均康复出院。其中,较具代表性的为1例升主动脉置换术和1例二尖瓣置换患者,两位患者均在术后1年复查CT,显示胸骨切口骨质已融合,达到解剖愈合。11例患者DSWI的发病时间为(20.9+5.4)d,住院时间为(19.4+8.7)d,手术的持续时间为(105.0+10.5)min,术中出血量为(114.5+49.3)mL。术中随访最长达5年,伤口无复发。结论 使用抗菌薇乔线闭合胸骨修复DSWI的方法可行,有着较短的住院时间及可控的术中出血量,是一种简易且有前景的治疗方法。

Objectives To observe the effect of closing the sternum with antibacterial Vicryl suture in 11 patients with deep sternal wound infection(DSWI)after median thoracotomy.Methods From December 2016 to March 2019,clinical data of 11 patients with DSWI who were treated with antibacterial Vicryl suture in Guangdong Provincial People′s Hospital were collected,including age,gender,onset time,hospitalization duration,operation duration,intraoperative blood loss,and routine follow-up after operation.Results The age of the 11 patients ranged from 44 to 76 years(8 males and 3 females).All the patients were diagnosed with DSWI according to chest computed tomography(CT).After thorough debridement combined with negative pressure wound treatment for one week,all the patients was repaired with antibacterial Vicryl suture and the wound healed well.Among them,1 case of ascending aorta replacement and 1 case of mitral valve replacement were representative patients.CT showed that the bone of the sternal incision had fused and achieved anatomical healing after 1 year.The average onset duration of DSWI in 11 patients was(20.9+5.4)days,the average hospitalization duration was(19.4+8.7)days,the duration of operation was(105.0+10.5)minutes,and the intraoperative blood loss was(114.5+49.3)mL.The longest follow-up period was 5 years,and there was no wound recurrence.Conclusions It is feasible to reconstructive the DSWI by closing with antibacterial Vicryl suture,which has shorter hospital stay and controllable intraoperative blood loss.It is a simple and promising treatment method.