主动脉感染性假性动脉瘤的腔内治疗  

Endovascular treatment for infected aortic pseudoaneurysm

作　　者：陆华[1] 赵志青[1] 景在平[1] 冯睿[1] 包俊敏[1] 曲乐丰[1] 魏小龙[1] 

机构地区：[1]第二军医大学附属长海医院血管外科全军血管外科研究所,上海200433

出　　处：《外科理论与实践》2011年第2期143-146,共4页Journal of Surgery Concepts & Practice

摘　　要：目的：探讨使用腔内修复术治疗主动脉感染性假性动脉瘤的有效性。方法：回顾性分析2007年1月到2010年1月期间的主动脉感染性假性动脉瘤病人的临床资料,包括临床表现、治疗方式、治疗效果及预后。结果：6例病人（平均年龄53岁）均行腔内修复术。1例病人并发主动脉支气管瘘,1例病人并发主动脉十二指肠瘘,4例为肾下腹主动脉假性动脉瘤（其中1例于麻醉后出现包裹性破裂）。所有病人于术中均行隔绝成功,静脉使用抗生素1~4周伴随终身口服抗生素,平均住院22 d。围手术期无死亡及并发症。2例主动脉瘘的病人在随访期中死亡。1例病人术后随访发现并发腰大肌脓肿;其余病人在术后随访期间恢复良好。结论：腔内修复术可作为主动脉感染性假性动脉瘤病人挽救生命的良好选择,但主动脉支气管瘘或主动脉肠瘘等意味着持续性感染存在的可能,必须于术后严密随访,必要时需行进一步外科手术治疗。Objective To investigate the efficacy of endovascular stent repair in the infected aortic pseudoaneurysm.Methods Clinical data of the patients with infected aortic pseudoaneurysm treated with endovascular stent repair,admitted from Jan 2007 to Jan 2010,were analyzed retrospectively.Results There were six patients with a mean age of 53 years.One of the patients was complicated by an aortobronchial fistula,one had an aortoduodenal fistula,four were infrarenal aortic aneurysms.Endovascular stent-grafts were deployed successfully in all patients,with complete exclusion of the pseudoaneurysms.Intravenous antibiotics were continued for 1 to 4 weeks and followed by lifelong maintenance of oral antibiotics.The median hospital stay was 22 days,with no perioperative mortality.Two patients with aortobronchial fistula and aortoduodenal fistula died during the follow-up period.The other four patients remained well,with one patient complicated by an abscess of the psoas muscle.Conclusions Endovascular repair could be a life-saving method for the infected pseudoaneurysms of the aorta.Strict surveillance is essential to observe the occurrence of aortobronchial fistula or aortoduodenal fistula;further interference should be considered when necessary.

关 键 词：主动脉 感染性假性动脉瘤 腔内修复术 

分 类 号：R543.16[医药卫生—心血管疾病]