感染性动脉疾病移植物的合理选择  

Rational selection of grafts for infectious arterial diseases

作　　者：符伟国 岳嘉宁 王琪 FU Wei-guo;YUE Jia-ning;WANG Qi(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200023,China)

机构地区：[1]复旦大学附属中山医院血管外科,上海200023

出　　处：《中国实用外科杂志》2024年第12期1347-1350,共4页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划项目(No.2023YFC2412405)。

摘　　要：感染性动脉疾病是一种罕见但具有高致残率和死亡率的疾病,其治疗以感染灶的清除和血流重建为核心,其中移植物的选择对于手术成功及病人预后至关重要。根据具体情况,血流重建可分为原位重建和解剖外旁路重建,两者各有优缺点,需根据感染范围、微生物毒力和病人全身状况进行个体化选择。移植物选择包括以下几种类型:普通人工血管和支架型人工血管可用于局限性感染或无更适宜选择时;利福平浸泡的人工血管对金黄色葡萄球菌等革兰阳性菌有效,但对耐甲氧西林金黄色葡萄球菌(MRSA)效果有限;银涂层人工血管具有广谱抗菌作用,但对高毒力菌种效果尚存争议;自体静脉,尤其是大隐静脉,是非主动脉感染的首选材料,但对主髂动脉感染则需考虑新主髂动脉系统(NAIS)技术;冷冻保存的同种异体移植物适用于重症感染,但因需预定,难以满足急诊需求;异种移植物如牛心包补片提供了一种灵活且方便的选择,尤其在缺乏其他材料时;组织工程人类无细胞血管(HAVs)在临床研究中表现出良好的抗感染潜力,但尚处于试验阶段。感染性动脉疾病的治疗需结合抗感染药物及手术干预,感染灶的彻底切除与合适移植物的选择是降低再感染风险的关键。然而,目前尚无针对移植物选择的明确指南,决策仍需综合病人的全身状况、感染范围及抗生素敏感性等因素制定个体化治疗方案。Infectious arterial diseases are rare but carry high morbidity and mortality rates.Treatment focuses on eradicating infectious focus and restoring blood flow,with the choice of graft being critical for surgical success and patient prognosis.According to the detailed situation,revascularization strategies can be divided into in situ reconstruction and extra-anatomic bypass,each with specific advantages and disadvantages.The decision must be individualized based on the extent of infection,microbial virulence,and the patient's overall condition.Graft options include several types:standard synthetic grafts and stentgrafts can be used for localized infections or when no better alternatives are available;rifampin-soaked grafts are effective against Staphylococcus aureus and other Gram-positive bacteria,though less effective against methicillin-resistant Staphylococcus aureus(MRSA);silver-coated grafts offer broad-spectrum antimicrobial activity,but their efficacy against highly virulent strains remains controversial.Autologous veins,particularly the great saphenous vein,are the first choice for non-aortic infections,while for aortoiliac infections,the neo-aortoiliac system(NAIS) technique may be considered.Cryopreserved allografts are suitable for severe infections but are difficult to meet emergency needs due to reservation requirements.Xenografts,such as bovine pericardium patches,provide a flexible and convenient option,especially when other materials are unavailable.Human acellular vessels(HAVs) have shown promising anti-infective potential in clinical research but are still in experimental stages.The treatment of infectious arterial diseases requires a combination of antimicrobial therapy and surgical intervention.Complete debridement of infectious focus and appropriate graft selection are crucial for reducing the risk of reinfection.However,there are currently no definitive guidelines for graft selection,and decisions must be tailored to the patient's overall condition,extent of infection,and antibiotic susceptib

关 键 词：感染性动脉疾病 原位血运重建 血管移植物 人工血管 自体静脉 同种异体移植物 异种移植物 

分 类 号：R6[医药卫生—外科学]