Secondary aortoduodenal fistulas: Value of initial axillofemoral bypass
Secondary aortoduodenal fistulas: Value of initial axillofemoral bypass
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继发性主动脉十二指肠瘘：初始腋股转流术的价值
DOI：
10.1007/bf02021769
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发表时间：
1991
影响因子：
1.5
通讯作者：
R. Courbier
中科院分区：
文献类型：
--
作者：
P. Bergeron;Hugo Espinoza;P. Rudondy;M. Ferdani;Jacques Martin;J. Jausseran;R. Courbier
1970年1月至1989年4月，对20例继发性十二指肠瘘患者进行了手术治疗。当术前诊断明确且不需要紧急控制出血时，在同一手术中消融感染的人工主动脉移植物之前进行初始腋股旁路术。当诊断不确定或出血严重需要紧急剖腹手术时，治疗计划随时间而变化。直到1980年，我们进行了直接修复（3例）或主动脉移植物消融后，二次腋股动脉旁路（4例）。1980年后，手术顺序为1）必要时控制出血，2）腋股动脉旁路术，3）主动脉移植物消融。初次行腋股动脉旁路移植术的患者术后死亡率为2/13，而直接手术或初次主动脉移植物消融的患者术后死亡率为6/7。在术后存活的12例患者中，3例在术后4个月、12个月和14个月死于主动脉残端出血。两名患者插入了新的主动脉移植物。1例因腋股动脉旁路术后继发血栓形成，再次行腹主动脉移植物置换术，另1例因腋股动脉旁路术后继发血栓形成，再次行升胸主动脉-双股动脉旁路术。我们的结论是，在处理主动脉移植物之前进行初次腋股动脉旁路术可以改善继发性十二指肠瘘手术的近期预后。然而，这种手术并不能排除主动脉残端感染的可能性，这种感染可能导致复发性十二指肠瘘。感染或继发性闭塞的风险是最小的腋股动脉旁路。二次假体置换不是系统性必要的。
Between January 1970 and April 1989, 20 patients underwent operation for secondary aortoduodenal fistulas. When the preoperative diagnosis was certain and emergency control of bleeding not required, initial axillofemoral bypass was performed before ablation of the infected aortic prosthetic graft during the same operation. When diagnosis was uncertain or severity of bleeding required emergency laparotomy, the therapeutic plan varied over time. Until 1980, we performed either a direct repair (three cases) or the ablation of the aortic graft followed by secondary axillofemoral bypass (four cases). After 1980, the order of procedures was 1) control of bleeding whenever necessary, 2) axillofemoral bypass, and 3) ablation of the aortic graft. Postoperative mortality was two of 13 in patients undergoing initial axillofemoral bypass, compared with six of seven patients undergoing direct surgery or initial ablation of the aortic graft. Of the 12 patients surviving the postoperative period, three died of aortic stump hemorrhage, four, 12, and 14 months after operation. Two patients had a new aortic graft inserted. Repeat replacement of the abdominal aorta graft was performed in one case and ascending thoracic aortobifemoral bypass in the other because of secondary thrombosis of the axillofemoral bypass. We conclude that initial axillofemoral bypass before dealing with the aortic graft improves the immediate prognosis in operations for secondary aortoduodenal fistulas. This procedure does not, however, preclude the possibility of aortic stump infection which can lead to recurrent aortoduodenal fistula. The risk of infection or secondary occlusion of axillofemoral bypass is minimal. Secondary prosthetic replacement is not systematically necessary.