心脏术后胸骨正中切口感染的治疗策略

The treatment of median incisional infections of the breast bone after cardiac surgery

目的探讨心脏手术后胸骨正中切口感染的分类与治疗方法，以期更好的提高临床治疗效果．方法采用回顾顾性调查的方法，对2007年1月至2009年5月我院治疗的胸骨切口感染患者的相关因素及治疗结果进行分析。结果本组患者76例，其中29例在术后1个月内，7例为术后1～2个月，超过2个月以上39例。1例胸骨完全坏死，心脏外露，拟手术前1d死亡。76例患者中1例接受4次清创手术，13例清创2次，61例接受1次清创手术，一次修复成功率80．26％。14例深部感染患者采用伤口持续负压吸引（VAC）的方法辅助创而准备。乳腺组织瓣转移1例，59例行肌肉组织瓣转移，其中胸大肌肌瓣转移52例，腹直肌瓣转移7例。结论根据感染发生的时间和累及的深度，选用恰当的治疗方法可以取得良好的治疗效果。

Objective To investigate the new classification and proper treatment of infected median incision on the breast bone. Methods A retrospective study on the patients who performed the treatment of infected median inc, ision on the hreast hone from Jan 2007 to May 2009 was carried out. The characters of the sternal infection and the outcomes of the treatment were analyzed. Results Among 76 patients, 29 patients snffered incisonal infectiun within one month after cardiac surgery, 7 patients got the infection at 1 -2 months after the operation, 39 patients＇ infection happened at more than 2 months postoperatively. One patient died at the day before operation. One palient received 4 times dehrides, while 13 patients received 2 times, 61 received once. 14 patients received vacuum-assisted closure treatment. One patient repaired with breast tissue flap. 52 patients were treated with pectoral major muscle flap and 7 patients were treated with rectus abdominis muscle flap. Conclusion Good results would he obtained by the correct treatment based on the onsel time and depth of the sternal infection.