Segers Patrique, de Jong Antonius P, Kloek Jaap J, de Mol Bas A J M
Department of Cardio-thoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Interact Cardiovasc Thorac Surg. 2005 Dec;4(6):555-60. doi: 10.1510/icvts.2005.112714. Epub 2005 Aug 9.
Poststernotomy mediastinitis (PM) is a serious and potentially lethal condition with an overall incidence varying from 0.4-5%. There is little consensus on the ideal management of PM. The aim of this retrospective study was to investigate the effectiveness of topical negative pressure (TNP) therapy vs. traditional closed drainage techniques (CDT) as a treatment modality for PM. We reviewed the data of 10,467 patients who underwent median sternotomy between 1 January 1992 and 31 December 2003. During this period 63 patients were treated for PM. Twenty-nine of these patients were treated with TNP and 34 with conventional CDT. Primary points of interest were: treatment modalities, mortality, surgical site infection recurrence and, duration of therapy and hospital stay. In this series, the total incidence of poststernotomy mediastinitis was 0.6% with high morbidity rates. In the TNP group, lower rates of recurring infection, therapeutic failure and fewer defects at discharge were seen (P<0.05). In conclusion, the results of our series add further data to the knowledge that PM is an important cause of morbidity and mortality. TNP is a safe and adequate treatment modality for treating PM.
胸骨切开术后纵隔炎（PM）是一种严重且可能致命的疾病，总体发病率在0.4%至5%之间。对于PM的理想治疗方法，目前几乎没有共识。这项回顾性研究的目的是调查局部负压（TNP）疗法与传统闭式引流技术（CDT）作为PM治疗方式的有效性。我们回顾了1992年1月1日至2003年12月31日期间接受正中胸骨切开术的10467例患者的数据。在此期间，有63例患者接受了PM治疗。其中29例患者接受了TNP治疗，34例接受了传统CDT治疗。主要关注的要点包括：治疗方式、死亡率、手术部位感染复发情况、治疗持续时间和住院时间。在本系列研究中，胸骨切开术后纵隔炎的总发病率为0.6%，发病率较高。在TNP组中，感染复发率、治疗失败率较低，出院时的缺损较少（P<0.05）。总之，我们系列研究的结果进一步补充了相关数据，即PM是发病和死亡的重要原因。TNP是治疗PM的一种安全且合适的治疗方式。
