12年连续冠脉搭桥手术后无胸骨哆开的临床经验

No sternal dehiscence after coronary artery bypass grafting over 12 years

目的 回顾性分析我院完成的2243例冠状动脉旁路移植术术后伤口并发症情况,总结冠脉搭桥正中手术切口术中及术后处理要点.方法 自1997年3月至2015年12月,排除围术期死亡患者,连续完成冠状动脉旁路移植手术2243例,患者年龄33～87岁.所有患者均以胸骨正中切口入路,心脏旁路手术完成后采用常规方法关胸,但结合患者情况确定个体化关胸策略.对比分析不同时段术后切口并发症包括胸骨哆开情况.结果 全组患者共发生术后胸骨哆开4例（0.54％）,均发生于2003年前（730例）,经二次固定后痊愈.2003年后完成的1513例患者无一例发生胸骨哆开.其中单一手术组完成的1 130例正中开胸冠脉搭桥手术,胸部切口局部脂肪液化15例,给予减张缝合局部酒精湿敷后干燥愈合.伤口胸骨皮下组织裂开8例（0.7％）,均经换药并二期缝合痊愈.3例患者因无菌性骨髓炎,给予胸骨坏死组织清除、胸大肌填埋成形术后痊愈.结论 心脏手术胸部正中切口并发症重在预防：开胸时注意切口保护、采用个体化胸骨固定技术、术后严格控制血糖水平、使用胸部固定带等综合措施的合理应用,可以大大降低冠状动脉旁路移植手术后切口并发症发生率.

Objective To summarize the key point on prevention of sternal dehiscence after coronary artery bypass grafting. Methods 2243 patients who received coronary artery bypass grafting （CABG） continuously were analyzed retrospectively to observe the incision complications including sternal dehiscence. All patients under- went sternal incision and CABG with or without concomitant procedure. The sternal closures were performed via conventional but individualized method. The morbidity of incision complications in different time was comparatively analyzed. Results 4 of 730 patients before 2003（0.54% ） suffered sternal dehiscence and recovered through reclo- sure procedure. No sternal dehiscence was found after 2003. The total incision complications morbidity of 1130 pa- tients who received CABG performed by single surgical team was 2.0%. Conclusion More attention should be paid to prevention of sternal incision complications after CABG. The integrated measures such as incision protec- tion, individualized sternal closure technique and perioperative glucose control should be emphasized to decrease the morbidity significantly.