目的:探讨开胸心脏瓣膜替换术后胸壁瘘及慢性化脓性肋软骨炎的处理方法。方法:对单根的肋软骨炎并胸壁瘘者,在压痛最明显处直接切除受累的肋软骨及窦道组织;对伴瘘的胸部多根肋软骨炎,可在经胸壁相对正常处切开,建立以远离感染部位为蒂的开放胸部皮瓣,经瘘口加压注入美蓝使受累的肋软骨及坏死筋膜染色,沿染色部完整切除受累的肋软骨及筋膜、瘘管周围组织;在手术创面皮瓣下置放盆式多孔引流管,术后持续低负压吸引,选用敏感抗生素。结果:本组3例,术后6天拨管,10天后伤口愈合,效果良好。结论:经正常皮肤切口入路,建立开放胸壁皮瓣,彻底清除感染坏死的肋软骨及瘘管周围组织是治疗开胸心脏换瓣术后胸壁瘘及慢性化脓性肋软骨炎的可靠方法。
Citation：
YANG Zhiming,XU Junyi,WEI Wuli. Treatment for the Fistula of Chest Wall and Chronic Suppurative Costochondritis following Heart ValveReplaced Operation. West China Medical Journal, 2009, 24(6): 1519-1521. doi:
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- 1. WILLIAMS C D, CUNNINGHAM J N, FALK E A, et al. Chronic infection of the costal cartilages after thoracic surgical procedures[J]. J Thorac Cardiovasc Surg. 1973, 66(4):592-598.
- 2. LAWRENCE W. WAY. 现代外科疾病的诊断与治疗[M].纪宗正,黎一鸣,主译. 第 10 版. 北京:人民卫生出版社, 1998: 334.
- 3. SHIELDS T W. General thoracic surgery[M]. 2 ng ed. Hiladelphia, 1983: 440.
- 4. TALUCCI R C, WEBB W R. Costal chondritis: the costal arch[J]. Ann Thorac Surg, 1983,35(3):318-321.
- 5. YOUNG J E, MILLER J D, URSCHEL J D. Costal chondritis after thoracoabdominal esophagectomy: how to prevent it[J]. J Surg Oncol, 2002, 80(1):61-62.
