Sjögren Johan, Gustafsson Ronny, Nilsson Johan, Malmsjö Malin, Ingemansson Richard
Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden.
Ann Thorac Surg. 2005 Jun;79(6):2049-55. doi: 10.1016/j.athoracsur.2004.12.048.
The conventional treatment for poststernotomy mediastinitis usually involves surgical revision, closed irrigation, or reconstruction with omentum or pectoral muscle flaps. Recently, vacuum-assisted closure has been successfully used in poststernotomy mediastinitis. The aim of the present study was to compare the clinical outcome and survival in 101 patients undergoing vacuum-assisted closure therapy or conventional treatment for poststernotomy mediastinitis.
One hundred one consecutive patients underwent treatment for poststernotomy mediastinitis: vacuum-assisted closure therapy (January 1999 through December 2003, n = 61) or conventional treatment (July 1994 through December 1998, n = 40). Follow-up was made in April 2004 and was 100% complete. Actuarial statistics were used to calculate the survival rates.
The 90-days mortality was 0% in the vacuum-assisted closure group and 15% in the conventional treatment group (p < 0.01). The failure rate to first-line treatment with vacuum-assisted closure and conventional treatment were 0% and 37.5%, respectively (p < 0.001). There was no statistically significant difference in the recurrence of sternal fistulas after vacuum-assisted closure therapy or conventional treatment: 6.6% versus 5.0%, respectively. Overall survival in the vacuum-assisted closure group was significantly better (p < 0.05) than in the conventional treatment group: 97% versus 84% (6 months), 93% versus 82% (1 year), and 83% versus 59% (5 years).
Our findings support that vacuum-assisted closure therapy is a safe and reliable option in poststernotomy mediastinitis with excellent survival and a very low failure rate compared with conventional treatment.
胸骨切开术后纵隔炎的传统治疗通常包括手术翻修、闭式冲洗，或使用大网膜或胸肌瓣进行重建。最近，负压封闭引流已成功应用于胸骨切开术后纵隔炎的治疗。本研究的目的是比较101例接受负压封闭引流治疗或传统治疗的胸骨切开术后纵隔炎患者的临床结局和生存率。
101例连续的胸骨切开术后纵隔炎患者接受了治疗：负压封闭引流治疗（1999年1月至2003年12月，n = 61）或传统治疗（1994年7月至1998年12月，n = 40）。2004年4月进行随访，随访率为100%。采用精算统计方法计算生存率。
负压封闭引流组90天死亡率为0%，传统治疗组为15%（p < 0.01）。负压封闭引流和传统治疗一线治疗的失败率分别为0%和37.5%（p < 0.001）。负压封闭引流治疗或传统治疗后胸骨瘘复发率无统计学显著差异：分别为6.6%和5.0%。负压封闭引流组的总体生存率显著高于传统治疗组（p < 0.05）：6个月时为97%对84%，1年时为93%对82%，5年时为83%对59%。
我们的研究结果支持，与传统治疗相比，负压封闭引流治疗在胸骨切开术后纵隔炎中是一种安全可靠的选择，生存率高且失败率极低。
