主动脉瘤腔内修复术后移植物感染诊治  

Diagnosis and treatment of graft infection following endovascular aortic aneurysm repair

作　　者：宁俊杰 常光其[1] NING Jun-jie;CHANG Guang-qi(Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血管外科,广东广州510080

出　　处：《中国实用外科杂志》2024年第12期1366-1371,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82170510)。

摘　　要：主动脉瘤腔内修复术后移植物感染(AEI)是主动脉瘤腔内修复(EVAR)术后一种罕见但可能致命的并发症。目前尚无大规模的前瞻性临床研究可确定AEI的最佳治疗方法。任何部位的感染都可能成为AEI的致病因素。AEI的临床表现从无症状、乏力、发热,到疼痛、体重减轻、消化道出血甚至休克不等。AEI的诊断需要结合临床表现、影像学检查及实验室检验结果等多方面的证据,目前最常用的诊断标准是主动脉移植物感染管理合作组织提出的标准。AEI首选治疗方法是完全切除感染移植物,然后根据具体情况行原位主动脉重建或解剖外旁路手术。对预期寿命短而手术风险高的病人,可考虑行移植物部分切除术或单纯保守治疗(根据培养结果和药敏试验选择有针对性的抗生素,长期抗感染治疗,辅以经皮穿刺引流和脓肿局部抗菌溶液冲洗)。为有效预防AEI,应严格筛选合适的EVAR病例,术中遵循无菌原则,并降低再干预率。Aortic endograft infection(AEI) is a rare but potentially fatal complication after endovascular aneurysm repair(EVAR).There is currently no large-scale prospective clinical study to determine the optimal treatment for AEI.Infection at any site may be the causative pathogen for AEI.The clinical manifestations of AEI range from asymptomatic,fatigue,fever,pain,weight loss,and gastrointestinal bleeding,to the most severe shock.The diagnosis of AEI requires a combination of multifaceted evidence,including clinical manifestations,imaging examinations,and laboratory test results.The most common diagnosis criteria are proposed by the Management of Aortic Graft Infection Collaboration(MAGIC).The preferred treatment for AEI is complete removal of the infected graft,followed by in situ aortic reconstruction or extra-anatomical bypass surgery,depending on the specific circumstances.For patients with a short life expectancy and high surgical risks,partial graft resection or conservative treatment(long-term anti-infection treatment with selected antibiotics based on culture results and drug sensitivity test results,supplemented by percutaneous drainage and antimicrobial solution irrigation of localized abscesses) can be considered.To effectively prevent AEI,appropriate patients for EVAR should be strictly selected,the principle of sterility should be followed during the procedure,and the reintervention rate should be reduced.

关 键 词：主动脉瘤腔内修复术 主动脉移植物 移植物感染 影像学检查 抗生素治疗 手术治疗 血管外科 治疗方案 

分 类 号：R6[医药卫生—外科学]