Kyoku I, Yokota M, Kitano M, Mizuhara H, Sakamoto K, Uesaka T, Hasegawa S, Park S, Muraoka R
Department of Cardiovascular Surgery, Shizuoka Children's Hospital, Japan.
Nihon Geka Hokan. 1990 Mar 1;59(2):168-72.
Mediastinal infection is one of serve and fatal complications after cardiac surgery, especially in the presence of an artificial graft. A case of successful treatment by using a pedicled omental flap for mediastinal infection in the presence of an external valved conduit is reported. a 10-year-old girl who had implanted the 12 mm porcine valved conduit for truncus arteriosus at age 9 months, underwent replacement of the old conduit with a 18 mm valved conduit. On the 9th postoperative day, as soon as mediastinal infection was proved by positive culture of the drainage from the chest tube, a reoperation was performed to debride and irrigate the mediastinum. Irrigation with povidone-iodine and antibiotics was continued for 3 weeks until improvement of CRP levels and negative drainage cultures. Then the heart and the valved conduit were wrapped with the pedicled omental flap and the skin was closed. She was without any evidence of infection for 3 months after operation. Use of a pedicled omental flap might be an effective method for treatment of mediastinal infection in the presence of an external conduit.
纵隔感染是心脏手术后严重且致命的并发症之一，尤其是在有人造移植物的情况下。本文报道了一例在存在体外带瓣管道的情况下，使用带蒂大网膜瓣成功治疗纵隔感染的病例。一名10岁女孩在9个月大时植入了12毫米猪带瓣管道用于治疗动脉干，此次接受了用18毫米带瓣管道替换旧管道的手术。术后第9天，胸腔引流液培养阳性证实纵隔感染后，立即进行再次手术，对纵隔进行清创和冲洗。用聚维酮碘和抗生素冲洗持续3周，直到CRP水平改善且引流液培养阴性。然后用带蒂大网膜瓣包裹心脏和带瓣管道，关闭皮肤。术后3个月她没有任何感染迹象。在存在体外管道的情况下，使用带蒂大网膜瓣可能是治疗纵隔感染的有效方法。
