腹主动脉腔内移植物感染单中心诊治及预后分析  

Single-centre diagnosis,treatment and prognostic analysis of abdominal aortic endograft infection

作　　者：王学斌 刘彬[1] 张喆[1] 于宏志[1] 张志文[1] 连利珊[1] 高翔[1] 冯海[1] 陈学明[1] Wang Xuebin;Liu Bin;Zhang Zhe;Yu Hongzhi;Zhang Zhiwen;Lian Lishan;Gao Xiang;Feng Hai;Chen Xueming(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050

出　　处：《国际外科学杂志》2024年第11期759-765,F0004,共8页International Journal of Surgery

基　　金：北京市自然科学基金—大兴创新联合基金(L246033)。

摘　　要：目的总结分析腹主动脉腔内移植物感染的诊治经验。方法回顾性分析首都医科大学附属北京友谊医院2018年1月—2024年6月收治的14例腹主动脉腔内移植物感染患者的一般资料、临床表现、实验室及影像学检查结果、致病菌和治疗方式选择,并对患者预后情况及与预后相关因素进行分析。结果14例患者细菌培养阳性为10例。1例非手术治疗患者因感染中毒性休克死亡。13例手术治疗的患者均行腋-双股动脉旁路,感染支架取出,主动脉残端闭合。13例手术患者中合并主动脉肠瘘4例,3例进行了一期肠管瘘口修补,1例仅行瘘口引流,3例行胃空肠吻合术,所有患者均进行了胃或空肠营养管置入术。13例患者中有2例感染灶波及肾动脉开口,为挽救肾脏,1例患者术中行左肾自体肾移植,另1例患者行腹腔干动脉-左肾动脉、肠系膜上动脉-右肾动脉的自体大隐静脉重建。2024年8月对14例手术患者进行回顾总结及随访,术后早期(<3个月)死亡5例,中长期(≥3个月)死亡3例,5例存活,存活患者中位随访时间2年(1~5年)。13例手术患者中合并主动脉肠瘘4例,术后早期死亡3例;腹主动脉感染灶累及肾动脉开口4例,术后早期死亡2例;合并胸腔积液4例,术后早期死亡4例;合并肌酐升高2例,术后早期死亡2例;术后人工血管感染2例。结论腹主动脉腔内移植物感染病情凶险。高龄、一般状况不佳、合并主动脉肠瘘或已存在心、肺、肝、肾等脏器功能不全的患者早期死亡风险增加,但基于充分抗感染治疗的外科手术仍然是挽救患者生命的有效手段。ObjectiveTo summarise and analyse the experience in the diagnosis and management of abdominal aortic endograft infection in recent years.MethodsRetrospectively summarised and analysed the general data,clinical presentation,laboratory and imaging findings,causative organisms and treatment choices of 14 patients with abdominal aortic endograft infection treated in Beijing Friendship Hospital,Capital Medical University,from January 2018 to June 2024,and analysed the prognosis of the patients and the risk factors associated with prognosis.ResultsPositive bacterial cultures were 10 out of 14 patients.One non-operatively treated patient died of infectious toxic shock.Thirteen surgically treated patients underwent axillary-bifemoral artery bypass,removal of the infected stent,and closure of the aortic stump.Four of the 13 cases had combined aortoenteric fistula,3 cases underwent one-stage enterocutaneous fistula repair,1 case only fistula drainage,3 cases of gastrojejunal anastomosis,all of them underwent gastric or jejunal nutrient tube implantation.Two of the 13 patients had combined the infection foci spread to the renal artery openings.To save the kidney,intraoperative left kidney autologous renal transplantation was performed in 1 case,and autologous saphenous vein reconstruction from celiac trunk artery-left renal artery and superior mesenteric artery-right renal artery was performed in the other case.All 14 patients were retrospectively summarised and followed up in August 2024,with 5 deaths in the early postoperative period(<3 months),3 deaths in the mid-to long-term period(≥3 months),and 5 survivors,with a median follow-up time of 2 years(1-5 years)for surviving patients.Among the 13 operated patients,4 cases were combined with aortoenteric fistula,and 3 cases died in the early postoperative period;4 cases of abdominal aortic infection foci involving renal artery openings,2 cases of early postoperative death;4 cases with pleural effusion,4 cases died in the early postoperative period;2 cases of combined creat

关 键 词：主动脉 腹 腔内移植物感染 腋-双股动脉旁路 外科手术 诊断 治疗 预后 

分 类 号：R654.3[医药卫生—外科学]