早期心包切除治疗急性化脓性心包炎21例临床观察

Pericardiectomy for acute suppurative pericarditis of early stage: a report of 21 cases

目的总结急性化脓性心包炎的治疗经验. 方法回顾性分析21例急性化脓性心包炎早期施行心包切除术治疗的临床资料. 结果全组均在气管插管全麻下经左胸第四或第五肋间前外侧切口施行手术.心包切除范围两侧至膈神经前缘,左侧膈神经后方心包也尽量切除,上达主动脉和肺动脉根部,下至膈面.全组均顺利完成手术,无术中死亡,手术时间135～240 min,平均155 min.术后发生肺水肿2例,左肺不张1例,切口感染1例.术后体温恢复正常时间5～9 d,平均7 d.手术后住院时间11～25 d,平均15 d,全组均治愈出院.18例随访1～10年,无缩窄性心包炎发生. 结论早期心包切除治疗急性化脓性心包炎具有操作简单、安全可靠、并发症少、感染灶清除彻底、住院时间短及不会继发缩窄性心包炎等优点,是治疗化脓性心包炎较为理想的方法.

Objective To summarize the therapeutic experience of acute suppurative pericarditis. Methods The clinical data of 21 cases of acute suppurative pericarditis at early stage treated with pericardiectomy were retrospectively analyzed. Results Left anterolateral incision was made in all the patients under general anesthesia. The resection range was that the two sides were the anterior borders of phrenic nerve, the upper border was the root of aorta and pulmonary artery, and the inferior border was diaphragmatic surface. All patients survived the operation. The operation time was 135 min to 240 min with the mean time of 155 min. After the operation, two patients developed pulmonary edema, one atelectasis and one infection of incisional wound. It took 5 to 9 d for body temperature to return normal with an average of 7 d. The hospital stay was from li to 25 d （mean 15 d）. There was no patient suffered from constrictive pericarditis in 18 cases followed up for 1 to 10 years. Conclusion Pericardiectomy for acute suppurative pericarditis at early stage has many advantages, such as simple operation, safe and less complications.