目的:探討開胸心臟瓣膜替換術后胸壁瘺及慢性化膿性肋軟骨炎的處理方法。方法:對單根的肋軟骨炎并胸壁瘺者,在壓痛最明顯處直接切除受累的肋軟骨及竇道組織;對伴瘺的胸部多根肋軟骨炎,可在經胸壁相對正常處切開,建立以遠離感染部位為蒂的開放胸部皮瓣,經瘺口加壓注入美藍使受累的肋軟骨及壞死筋膜染色,沿染色部完整切除受累的肋軟骨及筋膜、瘺管周圍組織;在手術創面皮瓣下置放盆式多孔引流管,術后持續低負壓吸引,選用敏感抗生素。結果:本組3例,術后6天撥管,10天后傷口愈合,效果良好。結論:經正常皮膚切口入路,建立開放胸壁皮瓣,徹底清除感染壞死的肋軟骨及瘺管周圍組織是治療開胸心臟換瓣術后胸壁瘺及慢性化膿性肋軟骨炎的可靠方法。
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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- 2. LAWRENCE W. WAY. 現代外科疾病的診斷與治療[M].紀宗正,黎一鳴,主譯. 第 10 版. 北京:人民衛生出版社, 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.
