感染性腹主动脉瘤诊疗体会  

Experience in diagnosis and treatment of infected aortic aneurysms: an analysis of 8 cases

作　　者：戈小虎[1] 方青波[1] 管圣[1] 赛里木[1] 任昊[1] 田广磊[1] 

机构地区：[1]新疆维吾尔自治区人民医院血管外科,乌鲁木齐830001

出　　处：《中国血管外科杂志（电子版）》2012年第4期229-231,共3页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结感染性腹主动脉瘤的诊疗体会。方法回顾性分析我院2009年6月～2012年5月收治的8例感染性腹主动脉瘤患者的临床资料。2例采用外科手术治疗,行原位血管重建;3例采用腔内修复术,3例未行手术。结果成功手术5例,随访6～12个月,中位随访时间10个月。原位血管重建2例:1例术后2个月出现吻合口破裂大出血致死;1例出现人工血管-肠瘘,切除左髂支人工血管,两端缝扎,随访1年,未出现不良事件。腔内治疗3例,随访期间均未出现复发、支架再感染、支架移位、内漏等不良事件。未手术3例,均因感染性腹主动脉瘤破裂死亡。结论感染性腹主动脉瘤罕见,术前诊断率低,死亡率极高。按照其特有的症状、体征及影像学和病原学检查,明确诊断后,应先抗生素治疗,并根据不同情况选择个体化治疗方案。Objective To summarize the experience of diagnosis and treatment of infected abdominal aortic aneurysms. Methods Between June 2009 and May 2012, the data of 8 consecutive patients with infected abdominal aortic aneurysms were retrospectively analyzed. Vascular reconstruction was performed on 2 cases, endovascular repair on 3 and conservative treatment on 3. Results Five cases underwent operation successfully, and were followed up 6～12 months (mean, 10 months). Of 2 cases, who underwent the in situ revascularization,one died of bleeding of anastomotic rupture after operation 2 months, and the other one was found artificial blood vessels-intestinal fistula, then received operation again to remove the left iliac branch without any complications during the follow-up time. Three cases who underwent endovascular operation didn't develope aneurysms enlargement, stent-grafts migration, endoleak and infection during the follow-up time. Three cases who didn't undergo operation died of infection abdominal aortic aneurysm repture. Conclusion The infected abdominal aortic aneurysm is rare..Its preoperative diagnosis rate is low, and mortality is extremely high. Diagnosis is confirmed according to the specific symptom,imaging and etiology examination, then high intensity antibiotic treatment and individual therapy should be carried out.

关 键 词：感染性动脉瘤 腔内修复术 人工血管支架 

分 类 号：R654.3[医药卫生—外科学]