In patients with cardiac injuries caused by sewing needles is the surgical approach the recommended treatment?
In patients with cardiac injuries caused by sewing needles is the surgical approach the recommended treatment?
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DOI：
10.1510/icvts.2009.226167
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发表时间：
2010-05
影响因子：
--
通讯作者：
S. Perrotta;A. Perrotta;S. Lentini
中科院分区：
文献类型：
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作者：
S. Perrotta;A. Perrotta;S. Lentini
根据结构化方案编写心脏手术中的最佳证据主题。提出的问题是：“对于心脏缝合针损伤的患者，手术方法是推荐的治疗方法吗？”通过检索Medline，使用奥维德界面，对1950年至2009年8月的科学文献进行了综述。发现了626篇论文，其中24篇被认为与这一主题有关。对这些论文的作者、期刊、发表日期和国家、研究的患者组、研究类型、相关结局和结果进行列表。损伤的原因可能会延迟表现、诊断和治疗策略的时机。在综述文献中的几乎所有病例中，作者都通过手术将针头从心脏中取出。然而，在24篇论文中，4例患者接受了保守治疗。大多数作者建议尽早取出缝针，以防止移位和进一步的解剖损伤。早期手术清除心脏异物被认为是预防并发症的有效方法。当异物位于心外时，心脏比异物完全位于心内时更容易受到严重损伤。心脏对着固定的异物的尖端不断运动会导致反复的出血和随后的心脏压塞。由于穿刺针有移位的趋势，因此提倡术前使用计算机断层扫描、经胸和经食管超声心动图来定位穿刺针的确切位置及其与周围组织的相关性。还建议术中使用心外膜超声或荧光镜检查。然而，在晚期诊断的情况下，在以前未经治疗的患者中，治疗可以个体化。如果症状不太严重，则可以采取保守的方法，因为随着时间的推移，大多数异物会安全地包囊并且不会造成伤害。患者可以保持多年无症状。然而，他们可能会在多年后出现并发症，如心包炎，心包填塞或心内膜炎。严格的随访对这些患者是有用的。
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with sewing needle cardiac injuries is the surgical approach the recommended treatment?' The scientific literature was reviewed by searching Medline, using Ovid interface, from 1950 to August 2009. Six hundred and twenty-six papers were found, of which 24 were deemed relevant to this topic. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The cause of injury may delay the timing of presentation the diagnosis and consequently the therapeutic strategy. In nearly all the cases in the reviewed papers the authors surgically removed the needle from the heart. However, out of the 24 papers, four patients had a conservative treatment. Most of the authors recommend early removal of the needle to prevent migration and further anatomical damage. The early surgical removal of foreign bodies in the heart is considered an effective approach to prevent complications. The heart is more vulnerable to serious injuries when the foreign body is extracardiac than when the foreign body is completely intracardiac. The unceasing motion of the heart against the sharp point of the fixed foreign body will result in repetitive wounding with bleeding and consequent cardiac tamponade. Due to the tendency of the needle to migrate, the preoperative use of computer tomography scan, trans-thoracic and trans-oesophageal echocardiography have been advocated to locate the exact position of the needle and its correlation with the surrounding tissues. The intraoperative use of epicardial ultrasound or fluoroscopy is also recommended. However, in cases of late diagnosis, in previously untreated patients, treatment can be individualized. If the symptoms are less severe it is reasonable to adopt a conservative approach as with time most foreign bodies become safely encysted and do no harm. Patients can remain asymptomatic for many years. However, they may present many years later with complications such as pericarditis, tamponade or endocarditis. Strict follow-up is useful in those patients.