Maddern I R, Goodman L R, Almassi G H, Haasler G B, McManus R P, Olinger G N
Department of Radiology, Medical College of Wisconsin, Milwaukee 53226.
Radiology. 1993 Mar;186(3):665-70. doi: 10.1148/radiology.186.3.8430171.
Acute mediastinitis and sternal infection after sternotomy are potentially devastating complications, but considerable advances in treatment have been made during the past decade. Sternectomy followed by reconstruction with use of either an omental transposition or a muscle flap has markedly decreased mortality and morbidity. After extensive rib resection, various reconstructive repairs, including the use of polytetrafluoroethylene mesh, have proved successful. The authors retrospectively reviewed 27 postoperative computed tomographic (CT) scans obtained in 19 patients. Twelve of these patients had sternal wounds repaired with either omental or muscle flap procedures. Seven patients had chest wall reconstructions with polytetrafluoroethylene patches, muscle transpositions, or both. The authors found no cases of unexpected or unexplained fluid collections on CT scans obtained beyond the 1st month. Any persistent or recurrent collection is suggestive of infection. If clinical and imaging findings are at odds, imaging-directed needle aspiration can help determine whether a fluid collection is infected and in need of further treatment.
胸骨切开术后的急性纵隔炎和胸骨感染是具有潜在毁灭性的并发症，但在过去十年中治疗方面取得了相当大的进展。胸骨切除术后采用网膜移位或肌瓣重建已显著降低了死亡率和发病率。在广泛肋骨切除术后，包括使用聚四氟乙烯网片在内的各种重建修复已被证明是成功的。作者回顾性分析了19例患者术后的27份计算机断层扫描（CT）图像。其中12例患者采用网膜或肌瓣手术修复胸骨伤口。7例患者采用聚四氟乙烯补片、肌肉移位或两者结合进行胸壁重建。作者发现，术后第1个月以后的CT扫描中未出现意外或无法解释的积液病例。任何持续性或复发性积液都提示有感染。如果临床和影像学表现不一致，影像引导下的针吸活检有助于确定积液是否感染以及是否需要进一步治疗。
