INFECTED INFRARENAL AORTIC-ANEURYSMS - WHEN IS INSITU RECONSTRUCTION SAFE
INFECTED INFRARENAL AORTIC-ANEURYSMS - WHEN IS INSITU RECONSTRUCTION SAFE
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DOI：
10.1016/0741-5214(93)90105-u
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发表时间：
1993-04-01
影响因子：
4.3
通讯作者：
CORMIER, JM
中科院分区：
文献类型：
--
作者：
FICHELLE, JM;TABET, G;CORMIER, JM
对 1968 年至 1989 年间手术的 25 例感染性肾下主动脉瘤进行了回顾。它们被分为栓塞后（真菌性）动脉瘤（第一组）、感染性主动脉炎（第二组）和感染性动脉粥样硬化动脉瘤（第三组）。八名患者发现主动脉十二指肠瘘，两名患者发现主动脉腔静脉瘘。 5 名患者在休克状态下接受手术，12 名患者术前血培养呈阳性。外科手术包括主动脉原位重建（n = 21）和与动脉瘤切除相关的解剖外搭桥术（n = 4）。 19 名患者的假体被大网膜瓣覆盖，所有患者均持续使用抗生素超过 6 周。在接受原位重建的患者中，三例死亡与初次手术有关。所有幸存的患者都接受了定期随访，没有人显示出任何晚期脓毒症复发的迹象。在接受解剖外搭桥的患者中，两名患者在术后死亡，一名患者在初次手术后两年接受了再次手术，最后一名患者情况良好。术后血培养阳性 (n = 4) 显示持续性脓毒症：2 例胆囊炎、1 例脊柱炎和 1 例主动脉感染。对文献进行了详尽的审查；分析临床、细菌学和手术特征及结果；评估预后因素；并提出了实用的治疗方法。强调了术前诊断、完全切除、感染组织清创、大网膜瓣覆盖以及长期抗生素治疗和定期计算机断层扫描随访的重要性。
Twenty-five infected infrarenal aortic aneurysms operated on between 1968 and 1989 were reviewed. They were classified into postembotic (mycotic) aneurysms (group I), infective aortitis (group II), and infected atherosclerotic aneurysms (group III). Aortoduodenal fistulas were found in eight patients and aortocaval in two. Five patients were operated on in a state of shock, and 12 had preoperative positive blood cultures. Surgical procedures included in situ reconstruction of the aorta (n = 21) and extraanatomic bypass associated with aneurysmal resection (n = 4). In 19 patients, prostheses were covered with omental flaps, and antibiotics were continued for more than 6 weeks in all patients. In patients who underwent in situ reconstruction, three deaths were related to the initial surgery. All surviving patients were regularly followed up, and none showed any sign of late septic recurrence. In patients who underwent extraanatomic bypass, two died in the postoperative period, one underwent reoperation 2 years after the initial surgery, and the last patient is doing well. Positive postoperative blood cultures (n = 4) revealed persistent sepsis: two cholecystitis, one spondylitis, and one aortic infection. An exhaustive review of the literature was performed; clinical, bacteriologic, and operative features and results were analyzed; prognostic factors were evaluated; and a practical therapeutic approach was suggested. The importance of preoperative diagnosis, complete resection, debridement of infected tissues, omental flap coverage, and long-term antibiotic therapy with regular computerized tomographic scanning follow-up is stressed.