腹主动脉瘤腔内修复术后支架感染诊治分析  

Management of endo-graft infection following endovascular repair of abdominal aortic aneurysm

作　　者：殷恒讳[1] 王冕[1] 李梓伦[1] 姚陈[1] 胡作军[1] 王劲松[1] 常光其[1] 王深明[1] 

机构地区：[1]中山大学附属第一医院血管外科,广州510080

出　　处：《中华医学杂志》2016年第30期2410-2414,共5页National Medical Journal of China

摘　　要：目的总结腹主动脉瘤腔内修复（EVAR）术后支架感染的诊治经验。方法 回顾性总结了2000年1月至2015年12月中山大学附属第一医院收治的EVAR术后支架感染病例资料，对感染的原因、临床表现、诊断方法、再次干预方式及和预后进行分析。结果 收治的患者共有10例EVAR术后支架感染病例，均为男性，年龄45～72岁（平均62.5岁）。其中2例初次EVAR手术于我院进行，占我院同期EVAR手术的0.23%（2/885）。本次发病与EVAR手术间隔0～27个月（平均6.9个月），主要临床表现为反复发热（100%）及腰背部疼痛（40%）。8例患者有明确感染诱因（80.0%），其中腹主动脉瘤肠瘘4例（40%），炎性动脉瘤3例（30%），上呼吸道感染并败血症1例（10%）。9例患者接受了二次手术干预，其中局部清创＋引流1例，支架切除＋双侧腋动脉－股动脉人工血管旁路1例，支架移除＋右侧腋动脉－双侧股动脉人工血管旁路7例。随访2～60个月（平均24.1个月），1例失访，1例术后死于腹主动脉残端破裂（12.5%），7例迄今存活，其中1例解剖外旁路闭塞（12.5%）但无严重下肢缺血。结论 腹主动脉瘤肠瘘和炎性腹主动脉瘤是本组病例支架感染的主要原因，在充分抗炎治疗的基础上建立解剖外旁路并移除移植物是有效的治疗手段。ObjectiveTo summarize our experience in the management of stent-graft infection after endo-vascular aortic repair （EVAR） of abdominal aortic aneurysm （AAA）.MethodsData of patients who were diagnosed as endo-graft infection following EVAR and admitted in our center between January 2000 and December 2015 were reviewed. Clinical records including causes of infection, medical history, re-operative procedures, and prognostic data were analysed.ResultsA total of 10 male patients, aged 45-72 years （averaged 62.5 years）, were enrolled. Two patients received previous EVAR in our center, accounting for 0.23% of all the 885 EVAR procedures we conducted during the same period. The symptoms related to stent infection, including recurrent fever （100%） and persistent back pain （40%）, occured 0 to 27 months （averaged 6.9 months） after EVAR procedure. Eight patients were found to have apparent causes （80%）, including 1 case with upper respiratory infection and sepsis, 4 cases with aorto-enteric fistula （AEF） and 3 cases with inflammatory AAA. Except one DNR, other 9 patients received re-operation, including 1 procedure of open debridement and drainage, 1 procedure of endo-graft excision and bilateral axillary-femoral bypass, 7 procedures of endograft excision and axillary-bifemoral bypass. During the follow-up period（2-60 months, averaged 24.1 months）, 1 patient was lost, 1 patient died from aortic stump rupture （12.5%） and other 7 patients survived. Bypass occlusion was observed in 1 patient （12.5%） without severe limb ischemia.ConclusionsAEF and inflammatory AAA are two leading causes of endo-graft infection following EVAR in our patients. Graft excision and axillofemoral bypass is an acceptable management for this life-threatening morbidity.

关 键 词：腹主动脉瘤 移植物感染 腋-股动脉旁路 

分 类 号：R654.3[医药卫生—外科学]