自体股浅静脉再造主髂动脉系统治疗严重感染性腹主动脉瘤:中国首批病例安全性及疗效分析  

Reconstruction of the aortoiliac system with autologous superficial femoral vein for severe infectious abdominal aortic aneurysm:safety and efficacy analysis of the first cases in China

作　　者：王琪 杨珏[1] 潘天岳[1] 方圆[1] 竺挺[1] 王利新[1] 阚远晴 周旻 陈璋璋[2] 董智慧[1] 符伟国[1] 岳嘉宁[1] WANG Qi;YANG Jue;PAN Tian-yue(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200023,China;不详)

机构地区：[1]复旦大学附属中山医院复旦大学血管外科研究所国家放射与治疗临床医学研究中心血管外科,上海200023 [2]复旦大学附属中山医院复旦大学血管外科研究所国家放射与治疗临床医学研究中心药剂科,上海200023

出　　处：《中国实用外科杂志》2024年第12期1382-1388,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金青年基金项目(No.82102146)。

摘　　要：目的 评估自体股浅静脉再造主髂动脉系统(NAIS)手术在感染性腹主动脉瘤(IAAA)治疗中的安全性与有效性。方法 回顾性分析复旦大学附属中山医院自2022—2024年接受NAIS手术治疗的12例IAAA病人的临床资料,包括术前诊断、术中处理及术后管理。所有病人均符合IAAA诊断标准,并通过术中采集病原学证据,结合药敏结果制定个体化抗生素治疗方案。随访评估手术疗效与远期预后。结果 12例病人中,11例获得明确的病原学诊断,其中7例为耐药病原菌感染。所有病人均成功完成手术,术后1例因吻合口破裂于术后10 d死亡,其余11例存活至随访期结束。病人术后入住ICU时间平均6.2 d,总住院时间平均23 d。抗生素治疗时间为17.2(2~37)周,平均随访时间64.9(13~130)周。11例存活病人中,10例摆脱抗生素依赖,无感染复发,1例截至2024年11月仍在口服抗生素治疗。术后及随访期间未出现筋膜室综合征或深静脉血栓后遗症,5例病人主诉静脉功能不全。CT影像随访未发现移植物瘤样变。结论 NAIS手术为IAAA提供了一种有效的原位血运重建策略,尤其适用于高感染负荷、耐药菌感染或抗生素治疗效果差的病人。尽管手术创伤较大,但抗生素依赖性显著降低,远期预后较好。在综合评估病人体质状况及感染复杂度后,NAIS手术可作为严重IAAA的首选治疗方案之一。Objective To evaluate the safety and efficacy of neo-aortoiliac system(NAIS) reconstruction using an autologous superficial femoral vein in the treatment of infectious abdominal aortic aneurysm(IAAA).Methods A retrospective analysis was conducted on the clinical data of 12 patients with IAAA who underwent NAIS surgery at Zhongshan Hospital,Fudan University,from 2022 to 2024.The analysis included preoperative diagnosis,intraoperative management,and postoperative care.All patients met the diagnostic criteria for IAAA,and intraoperative pathogen identification combined with susceptibility testing was performed to guide individualized antibiotic regimens.Follow-up assessments evaluated surgical outcomes and long-term prognosis.Results Among the 12 patients,11 had confirmed pathogen diagnoses,including 7 with multidrug-resistant organisms.All patients successfully underwent surgery.One patient died on postoperative day 10 due to anastomotic rupture,while the remaining 11 survived until the end of the follow-up period.The average ICU stay was 6.2 days,and the mean total hospital stay was 23 days.The duration of antibiotic therapy ranged from 2 to 37 weeks,withan average of 17.2 weeks.The mean follow-upduration was 64.9 weeks(13-130 weeks).Amongthe 11 surviving patients,10 were free fromantibiotic dependency without infectionrecurrence,while one still required long-termoral antibiotic therapy as of November 2024.No cases of compartment syndrome or post-thrombotic syndrome were reported,although 5 patients complained of venousinsufficiency symptoms.CT imaging follow-up revealed no graft-related aneurysmal changes.Conclusion NAISsurgery offers an effective strategy for in situ revascularization in IAAA,particularly for patients with high infectionburdens,multidrug-resistant organisms,or poor responses to antibiotic therapy.Despite the extensive surgical trauma,antibiotic dependency was significantly reduced,and long-term outcomes were favorable.NAIS surgery can beconsidered one of the preferred treatment options for sever

关 键 词：感染性腹主动脉瘤 自体股浅静脉 主髂动脉系统重建 自体静脉重建主髂动脉系统手术 感染负荷 抗生素治疗 血流重建 远期预后 

分 类 号：R6[医药卫生—外科学]