摘要
目的总结自体肌皮瓣植入治疗慢性难治性脓胸经验。方法2004年1月至2017年12月共有26例患者因慢性难治性脓胸于上海市肺科医院行自体肌皮瓣植入治疗。男24例，女2例；中位年龄50．1岁（17-74岁）。21例既往有肺切除病史（6例全肺切除），其中15例开窗时并发支气管胸膜瘘，保守治疗（引流等）无法治愈，再行胸壁开窗，长期换药。另5例无既往手术史，保守治疗（引流等）无法治愈，肺无法复张，开窗换药。结果全组无死亡，术后均无呼吸道并发症。5天内顺利拔除胸腔引流管，术后3-6周出院。中位随访9个月，24例无脓胸复发和皮瓣坏死，2例脓胸局部复发。结论应用自体肌皮瓣植入治疗慢性难治性脓胸是一种行之有效的方法，需不断完善。
Objective To summarize experience in the treatment of chronic refractory empyema with autologous myocuta- Menus flap implantation. Methods From January 2004 to December 2017, 26 patients had been treated with autologous myo- cutaneous flap implantation in Shanghai Pulmonary Hospital for chronic refractory empyema. Among them, 24 were men and 2 were women. The mediam age was 50.1 years（ 14 -74 years）. 21 of them had medical histories of lung resection because of basic diseases（ most of which accepted surgeries in other hospitals）. Complications appeared after surgeries. 15 of them had bronchopleural fistula while windowing, which could not be cured by conservative treatments such as drainage. Then we per- formed open-window thoracostomy and long-time dressing. 6 of 21 had experienced pneumonectomy. Other 5 patients did not have primary operational histories. They experienced dressing by windowing because of chronic refractory empyema after the in- effective conservative treatments like drainage without pulmonary re-expansion. Results No respiratory complications occurred in these patients. The catheters were successfully removed within 5 days and the patients were discharged within 3 - 6 weeks af- ter the operations. The median follow-up period was 9 months. 24 cases were successful with no recurrence of empyema or flap necrosis, the other 2 cases underwent recurrence of empyema. Conclusion The application of autologous myocutaneous flaps for the treatment of chronic refractory empyema is an effective and continuously improving method.
作者
瞿冀琛
李佳琪
谢博雄
姜格宁
董佳生
Qu Jichen; Li Jiaqi; Xie Boxiong; Jiang Gening; Dong Jiasheng(Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tonal University School of Medicine, Shanghai 200433, China; Department of Plastic Surgery, Number Nine Hospital, Medical College of Shanghai Jiao- tong University, Shanghai 200011 , China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2018年第10期613-616,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
慢性难治性脓胸
自体肌皮瓣
胸壁开窗术
Chronic refractory pleura empyema
Autologous myocutaneous flap
Open-window thoracostomy
