深部胸壁感染655例外科治疗的单中心回顾性分析

Surgical treatment of 655 patients with deep chest wall infection:A single-center retrospective analysis

目的探讨深部胸壁感染的外科治疗方法,以提高治愈率、降低复发率。方法回顾性分析河北医科大学附属燕达医院和北京中医药大学王府中西医结合医院2015年6月—2020年6月655例深部胸壁感染患者的临床资料,其中男450例、女205例,年龄(55.6±12.8)岁。肿瘤坏死胸壁感染8例,放疗后胸壁感染坏死15例,开胸术后胸壁感染632例(心脏大血管术后612例、普胸术后20例)。649例患者行清创及胸壁缺损肌瓣修复重建手术。结果平均手术时间(95±65)min,平均术中出血量(180±100)mL,平均术后住院时间(13±6)d。649例感染清创后肌瓣重建术中597例在术后2周内康复出院,伤口一期愈合率94.4%。全组患者死亡23例(3.5%)。中位随访时间25(2~40)个月,余632例患者中复发20例,复发率3.1%(20/632)。结论深部胸壁感染彻底清创后用帯蒂肌瓣修复胸壁缺损是最佳的治疗方法之一。

Objective To explore the surgical treatment of deep chest wall infection,improve the cure rate and reduce the recurrence rate.Methods The clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed.There were 450 males and 205 females,aged 55.6±12.8 years.There were 8 patients with chest wall infection after tumor necrosis,15 patients after radiotherapy and 632 patients after thoracotomy(612 patients after cardiovascular surgery and20 patients after general thoracic surgery).Among them,649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.Results The average operation time was 95±65 min,the average intraoperative blood loss was 180±100 mL,and the average postoperative hospital stay was 13±6 d.Of the 649 patients who underwent muscle flap reconstruction after debridement,597 patients recovered within 2 weeks,and the primary wound healing rate was 94.4%.Twenty-three(3.5%)patients died.The median follow-up time was 25(2-40)months.Among the remaining 632 patients,20 recurred,with a recurrence rate of 3.1%(20/632).Conclusion Pedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.