開心術後の縦隔炎に対する洗浄併用陰圧閉鎖療法

Treatment of Mediastinitis after Open Heart Surgery Using Negative Pressure Wound Therapy with Irrigation

心臓血管手術後の縦隔炎は，ひとたび発症すると生命予後の悪化や，入院期間延長，医療コストの増加など悪影響が大きく，多くの施設でCenters for Disease Control and Prevention（CDC）ガイドライン1）などに基づいた発症予防策がとられている．しかし開心術全体の数％に発症するとされ2，3），これまでにもさまざまな治療法が報告されてきた4～6）．当院での治療方法の工夫と今後の課題について検討した．

Mediastinitis occurs after open heart surgery in a small number of cases. When it occurs, early diagnosis and treatment are important. A 69-year-old male patient suffered from mediastinitis after total aortic arch replacement. He has cured completely by negative pressure wound therapy （NPWT） with irrigation method. The vacuum-assisted closure （VAC） method is very useful for wound repair and has recently been used to treat mediastinitis. However, the use of VAC alone does not always result in complete cure. NPWT with irrigation is a very useful infection control method. Performing NPWT before VAC might contribute to improving the outcomes of mediastinitis treatment. However, it is difficult to decide when to switch from NPWT with irrigation to VAC.