腔镜辅助获取腹直肌肌瓣修复胸骨切口深部感染清创术后创面的初步尝试

Feasibility of using rectus abdominis flaps harvested by video-assisted endoscopy in the treatment of thoracic defects after surgical debridement for deep sternal wound infection

目的:探讨腔镜辅助获取腹直肌肌瓣修复胸骨切口深部感染(DSWI)清创术后创面的可行性。方法:回顾性分析5例胸骨切口深部感染患者的临床资料。5例患者均行外科手术清创、全胸骨切除或大部分胸骨切除,同时切除部分肋软骨。游离两侧胸大肌之胸骨、肋骨起点,部分胸大肌联合带蒂腹直肌肌瓣填充胸骨缺损行一期重建。其中3例开放切取腹直肌肌瓣,2例在腔镜辅助下获取腹直肌肌瓣。观察患者的手术结果及并发症的发生情况。结果:5例患者手术切口均一期愈合。2例在腔镜辅助下获取腹直肌肌瓣的患者切口明显缩短、创伤减小、手术时间无明显增加。随访1～12个月,5例患者均无疼痛、感染复发、腹壁疝发生,呼吸功能明显改善。结论:对于胸骨切口深部感染严重、胸骨切除术后缺损大的患者,部分胸大肌联合带蒂腹直肌肌瓣填充胸骨缺损是一种较好的选择;腔镜辅助获取腹直肌肌瓣可明显减轻患者腹部创伤、术后疼痛,改善术后腹式呼吸,促进患者康复。

Objective:To investigate the feasibility of using rectus abdominis flaps harvested by video-assisted endoscopy in the treatment of thoracic defects after surgical debridement for deep sternal wound infection(DSWI).Methods:The clinical data of 5 patients with DSWI were analyzed retrospectively.All 5 patients underwent surgical treatment.Total sternums or most of the sternums were resected,and partial cost cartilages were removed,and the bilateral pectoralis major were partial dissociated.Then the thoracic defects were reconstructed with the rectus abdominis flaps and pectoralis majors by one stage,2 of 5 patients’rectus abdominis flaps were harvested by video-assisted endoscopy.The operation results and postoperative complications were observed.Results:All 5 patients were healed primarily without significant complications.Two patients with rectus abdominis flaps harvested by video-assisted endoscopy had decreased operation wound,and the operation time was not obviously extended.Follow-up for 1 to 12 months showed that all 5 patients had no pain,no recurrence of infection,no abdominal incisional hernia,and their respiration function improved significantly.Conclusions:Rectus abdominis flap is a good choice for the repair of sternal wound of patients who suffered from the extensive thoracic defects after deep sternal wound infection.The treatment with video-assisted endoscopy shows superior results,it can reduce the abdominal invasiveness and postoperative pain,improve abdominal respiration,and accelerate recovery.