27例人工血管内瘘移植物感染的处理策略  

Management strategy for the 27 cases with arteriovenous graft infections

作　　者：万恒[1] 刘灏[1] 林智琪[1] 刘正军[1] WAN Heng;LIU Hao;LIN Zhi-qi;LIU Zheng-jun(Department of Vascular Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院血管外科,广州510515

出　　处：《中国血液净化》2020年第7期478-481,共4页Chinese Journal of Blood Purification

基　　金：南方医科大学南方医院临床研究项目(编号:2019CR013);南方医科大学南方医院新业务新技术院级课题(2013028)。

摘　　要：目的总结透析用人工血管内瘘移植物感染的处理经验及策略。方法回顾性分析南方医科大学南方医院血管外科2015年1月~2019年1月收治的27例人工血管动静脉内瘘感染患者的临床资料。27例患者中,男性11例,女性16例。其中前臂人工血管移植物内瘘16例,上臂人工血管移植物内瘘7例,下肢人工血管移植物内瘘4例。人工血管移植物全段感染8例,人工血管移植物全段感染合并吻合口假性动脉瘤3例,人工血管局段感染15例,人工血管局段感染合并窃血综合征1例。处理方案包括:人工血管全部切除+动脉重建术13例,人工血管次全切除2例,人工血管局段切除+移植物旁路术11例,人工血管局段切除+移植物旁路术+流入道动脉近端化1例。结果 27例患者均获得技术上的成功,技术成功率100%,围手术期无患者死亡。所有患者均获随访,平均随访时间18.3(12~29)个月。随访期间1例左上臂人工血管移植物内瘘局段感染患者,采用人工血管次全切除术后2个月,再次出现人工血管动脉残端感染吻合口破裂,左侧腋动脉假性动脉瘤形成,采用自体贵要静脉旁路移植术修复左侧腋动脉;1例人工血管移植物内瘘局段感染的患者,接受人工血管局段切除+人工血管移植物旁路术治疗,术后8个月,再次出现人工血管局段感染并闭塞,行人工血管移植物完整切除术。余患者未出现吻合口及肢体缺血相关并发症(移植物全切除)以及移植物再次感染(保留移植物)。结论应根据人工血管移植物内瘘感染的类型采用正确的策略进行治疗,原则上尽可能保留移植物,手术过程中的无菌操作以及后续的穿刺过程无菌技术有助于减少人工血管移植物感染的发生。Objective To summarize the management experience and strategy for the 27 cases with arteriovenous graft(AVG) infections. Methods Clinical data of the 27 patients(11 male cases and 16 female cases) with AVG infections during the period from January 2015 to January 2019 were retrospectively analyzed. The AVGs located in forearm in 16 cases, in upper arm in 7 cases, and in lower limbs in 4 cases. Whole segment infections of the AVG were found in 8 cases, whole segment infections of the AVG with anastomotic pseudoaneurysm in 3 cases, local infections of the AVG in 15 cases, and local infection of the AVG with steal syndrome in one case. Treatments of the 27 cases included total resection of the AVG with artery reconstruction(13 cases), subtotal resection of the AVG(2 cases), partial resection of the AVG with new graft bypass(11 cases), and partial resection of the AVG with new graft bypass and proximal arterialization of inflow artery(one case). Results All the 27 patients achieved technical success(technical success rate was 100%).No patient died in the peri-operative period. All patients were followed up for an average of 18.3(12~29)months. During the follow-up period, local infection of the AVG in left upper arm occurred in one case;after subtotal resection of the AVG for two months, rupture of the infected anastomotic orifice at the arterial end of artificial blood vessel and pseudoaneurysm formation in left axillary artery appeared in this case, and the left axillary artery was repaired by autologous basilic vein bypass. One case with local infection of the AVG was treated with partial resection of the AVG with new graft bypass;after the treatment for 8 months, local infection and occlusion of the graft occurred again, and the infected graft was completely resected. Ischemia at the anastomotic orifices and limbs and its related complications(total graft resection) and relapse of graft infections(graft preserved) were not found in other cases. Conclusion Right management strategy should be adopted according to th

关 键 词：人工血管动静脉内瘘 感染 处理策略 

分 类 号：R318.16[医药卫生—生物医学工程]