下肢动脉旁路术后人工血管感染的处理  

Management strategies of arterial prosthetic graft infection in lower extremity： a report of 5 cases

作　　者：齐立行[1] 许铮[1] 俞恒锡[1] 谷涌泉[1] 李学锋[1] 郭连瑞[1] 崔世军[1] 罗涛[1] 吴英锋[1] 李建新[1] 汪忠镐[1] 

机构地区：[1]首都医科大学血管外科研究所首都医科大学宣武医院血管外科,北京100053

出　　处：《中华医学杂志》2012年第47期3364-3366,共3页National Medical Journal of China

摘　　要：目的探讨动脉旁路术后人工血管感染的治疗方法。方法回顾性分析了2003年10月至2010年10月首都医科大学宣武医院血管外科收治的5例下肢人工血管化脓性感染的治疗。结果5例患者均先进行抗炎保守治疗和局部扩创引流；2例在感染得到基本控制的基础上行解剖外途径血管旁路移植和感染移植物去除术后治愈出院；1例在治疗期间因并发急性心肌梗死、感染中毒性休克死亡；2例去除人工血管后感染得到控制，但未行动脉血流重建，因肢体缺血坏死施行了膝上截肢术。结论人工血管一旦发生化脓性感染则很难治愈，保守治疗及一般清创手术效果往往不佳；而在感染得到基本控制后，先行动脉血流重建，再继以感染移植物去除术，则既能使感染得到治愈，又可避免远端肢体的缺血，并能降低血管移植物再次感染的风险。Objective To explore the management strategies of pyogenic vascular prosthetic graft infection. Methods The clinical data of 5 cases of prosthetic vascular graft infection in lower extremity between 2003 and 2010 were retrospectively analyzed. Results All of them were treated by antibiotics, debridement and drainage. One patient died from acute myocardial infarction and septic shock. Two patients were cured by extra-anatomic arterial bypass and removal of infected graft after a basic control of infections. And another two patients had the diseased limb amputated after the removal of infected vascular graft without blood reconstruction. Conclusion Pyogenic infection of vascular graft is hard to treat with conservative measures. Revascularization prior to removal of infected graft is recommended for a better outcome.

关 键 词：人工血管 感染 血管旁路移植 

分 类 号：R654.3[医药卫生—外科学]