血管重建治疗注射毒品所致股动脉假性动脉瘤

目的探讨注射毒品所致股动脉假性动脉瘤的外科治疗方法。方法对14例注射毒品所致股动脉假性动脉瘤患者的临床资料进行回顾分析。9例直接采用ePTFE人工血管行原位移植间置术;4例采用自体大隐静脉原位间置移植术;1例行单纯股深动脉结扎术。结果全部病例术后患肢供血良好,无肢体缺血表现,其中11例患者成功随访1～45个月,1例患者出院后出现伤口感染,余患者伤口均在1个月内愈合,现患肢均无缺血症状,活动自如。结论吸毒所致股动脉假性动脉瘤切除后血管重建有利于保证下肢血供,在患者不能提供合适的自体大隐静脉移植时,人工血管原位移植仍是治疗假性股动脉瘤的有效方法。术中彻底清创及术后伤口引流、加强抗炎是预防术后人工血管并发感染的最主要措施。     

感染性股动脉假性动脉瘤的外科治疗

目的 探讨感染性股动脉假性动脉瘤的外科治疗方法.方法 回顾性分析2003年1月至2008年6月期间我院收治的45例感染性股动脉假性动脉瘤行外科治疗患者的资料.43例感染性股动脉假性动脉瘤采用瘤体切除及彻底清创后行人工血管旁路移植治疗; 另2例由于感染严重及瘤体巨大被迫采用瘤体切除并行近、远端动脉结扎.结果 随访3～12个月,平均7.82个月,人工血管旁路移植病例全部保肢成功,切口均二期愈合,无间歇性跛行; 行动脉结扎的2例中,1例因缺血坏疽行膝上高位截肢; 另1例保肢成功,但有间歇性跛行.结论 动脉瘤切除及彻底清创后行人工血管旁路移植是感染性股动脉假性动脉瘤安全、有效的治疗方法.     

注射毒品致股动脉假性动脉瘤破溃感染的治疗

目的总结注射毒品致股动脉假性动脉瘤破溃感染的外科治疗方法。方法1994年3月～2004年10月,共收治因毒品注射致股动脉假性动脉瘤形成并破溃感染患者17例。男15例,女2例;年龄18～45岁。吸毒史2个月～10年,静脉注射史吸毒2～15个月,皮肤坏死1～6个月。皮肤坏死直径2～5cm,B超示包块大小15cm×10cm×8cm～18cm×13cm×10cm。急诊手术4例,择期手术13例。3例行人造血管移植,5例行远近端血管结扎,5例行静脉移植,2例动脉裂口直接缝合,2例行股深动脉移植。结果术后可触及足背动脉搏动恢复2例,增强3例。切口期愈合6例,期愈合8例,3例出现伤口感染。15例获随访3～18个月,2例同侧大隐静脉远端移植及2例人造血管移植者经B超检查示移植血管栓塞,5例血管腔(1例人造血管、2例自体静脉移植、2例动脉裂口直接缝合)变狭窄。随访者均基本恢复正常生活。结论注射毒品致股动脉假性动脉瘤形成并破溃感染患者,需手术治疗,争取择期手术,针对假性动脉瘤破溃时间超过1个月者,可考虑行远近端血管结扎术。     

人工血管旁路移植治疗感染性股动脉假性动脉瘤

目的探讨人工血管旁路移植术治疗感染性股动脉假性动脉瘤的效果。方法回顾性分析2005年1月—2010年12月40例感染性股动脉假性动脉瘤的临床资料,40例患者均为吸毒者,均接受了假性动脉瘤切除、彻底清创及人工血管旁路移植术。结果围手术期内无死亡患者,且均保肢成功,创口均二期愈合。34例(85.0%)术后获得随访3～12个月,平均7.4个月。随访期内发生移植物感染3例(8.8%),取出感染的移植物后2例保肢成功,1例最终因肢体缺血坏死而接受截肢术;彩超检查发现人工血管腔内部分血栓形成4例(11.8%),给予抗血小板治疗,远端肢体均无缺血坏死。结论人工血管旁路移植术是治疗注射吸毒所致感染性股动脉假性动脉瘤的安全、有效的方法。     

毒品注射致股动脉假性动脉瘤破裂出血的诊治

目的探讨注射毒品引起股动脉假性动脉瘤形成并破裂出血的诊断与治疗方法。方法回顾性分析2003年3月—2009年12月收治的22例因反复注射毒品致股动脉假性动脉瘤形成并破裂出血患者的临床资料。结果 22例患者均接受手术治疗,术中行瘤体切除、清创后,8例行股动脉破口修补术;4例行破口两侧股动脉结扎术;10例行髂外动脉-股动脉人工血管移植术。22例均手术成功,手术后早期出现人工血管与股动脉吻合口破裂出血1例,急诊手术重新吻合,随后出现切口感染,经换药后切口愈合。术后患侧下肢功能均好。随访6个月至7年,平均3年。1例患者术后2年出现人工血管感染,1例出院后14d发生吻合口出血,均经再次血管吻合治愈;2例股动脉结扎患者遗留轻间歇性跛行。结论治疗股动脉假性动脉瘤形成并破裂出血的手术方式,以股动脉假性动脉瘤切除+清创+股动脉修补术最为简单、安全有效;人工血管移植术疗效确定,能最大限度保证患肢血供;股动脉修补或结扎术在选择病例中也是有效的治疗方法。     

注射毒品所致感染性假性动脉瘤的血管重建17例

目的探讨注射毒品所致的感染性假性动脉瘤的治疗方法。方法1999年5月～2004年8月，对17例注射毒品所致感染性假性动脉瘤患者的临床资料进行回顾性分析。男16例，女1例，年龄24～38岁。除1例为肱动脉假性动脉瘤外，余16例均为股动脉假性动脉瘤。其中14例接受人工血管原位或旁路移植重建，1例行截肢手术，1例因休克未及时手术致死亡，1例放弃治疗。结果重建血管的14例患者中，13例恢复良好，近期均无远端肢体缺血表现；1例因术后感染再次手术截肢，术后恢复良好。术后3个月复查彩色多普勒显示，9例移植血管通畅，足背动脉搏动良好。结论感染性假性动脉瘤瘤体附近行人造血管重建是非常危险的，但在无适宜自体血管前提下，使用人造血管重建仍是一种有效的治疗方法。术后充分引流、强有力的抗生素及抗凝治疗是关键。     

肢体假性动脉瘤的临床诊治(附30例报道)

目的 探讨肢体假性动脉瘤的病因、发病机理以及手术方式的选择,评价各种手术的治疗效果,以提高对假性动脉瘤的诊治水平.方法 30例假性动脉瘤患者(股动脉18例,腘动脉7例,肱动脉2例,桡动脉3例),其中8例为感染或破裂性假性动脉瘤,1例肢体坏死.30例患者均行外科手术治疗,其中11例行假性动脉瘤破口修补术,2例行股动脉结扎术,2例行血管端端吻合术,8例行自体大隐静脉移植术,6例行人工血管移植术,1例行截肢术.结果 30例患者术后恢复顺利,除1例行下肢截肢术外,其余29例术后效果良好.随访7个月～8年,平均(4.4±2.3)年;行人工血管移植术者4例移植段发生血栓,经溶栓治疗后好转,其余血供状况良好.结论 外科手术治疗肢体假性动脉瘤是一种有效的方法.     

颈外静脉移植治疗注射毒品所致的假性股动脉瘤

目的探讨注射毒品致假性股动脉瘤的临床特点及颈外静脉移植治疗的可行性。方法2002年6月~2006年2月,对注射毒品所致的20例假性股动脉瘤行手术治疗,并移植颈外静脉重建股动脉缺损。结果所有病例均成功保存肢体,无缺血坏死及小腿骨筋膜室综合征发生。伤口一期愈合9例,余11例出现淋巴漏,二期愈合4例,再次手术行局部皮瓣转移修复7例。1例因吻合口破裂出血而结扎股动脉,1例有股神经损伤的表现。16例随访1~24个月,无复发,足背动脉可扪及搏动,10例术后血管彩超显示移植的颈外静脉通畅。结论手术是治疗注射毒品所致的假性股动脉瘤唯一有效的方法;在瘤体切除后大隐静脉往往因炎症而不能利用,移植颈外静脉修复重建股动脉缺损是可行的。     

注射毒品致股动脉感染性假性动脉瘤的血循环功能重建

目的探讨注射毒品致股动脉感染性假性动脉瘤的血循环重建方法。方法 2003年11月-2009年5月,收治84例因注射毒品致股动脉感染性假性动脉瘤患者。其中男67例,女17例;年龄19～51岁,平均34.6岁。注射毒品时间1～11年,平均2.7年。13例股动脉缺损3～10 cm,其余患者股动脉破口范围1.0 cm×0.3 cm～3.0 cm×0.7 cm。5例行ePTFE人工血管旁路转流,29例行自体大隐静脉移植,24例行股动脉破口修补,26例行股动脉结扎。结果 2例患者术中下肢深静脉血栓脱落致肺栓塞死亡。8例术后出现切口感染,拆除部分或全部缝线,经换药后切口愈合,其余患者切口均Ⅰ期愈合。56例行血管重建或修补的患者,术后足背动脉搏动恢复或增强,无远端肢体骨筋膜室综合征发生;26例行股动脉结扎的患者,术后1周行CT下肢动脉血管重建或下肢动脉造影显示肢体远端均有丰富来自同侧髂内动脉、臀上动脉以及对侧髂内动脉的侧支循环。82例术后获12～36个月随访,平均17.3个月。3例出现间歇性跛行,经扩血管,活血化瘀等药物治疗后好转,肢体功能良好;其余行走正常。结论注射吸毒致股动脉感染性假性动脉瘤应尽早外科手术治疗,彻底清创引流、髂外动脉-股浅动脉旁路带支撑环人工血管或大隐静脉重建以及破口修补,是有效的治疗方法。在感染严重、局部条件无法重建血管的情况下,结扎股动脉也是一种可行选择。     

股动脉注射毒品致假性动脉瘤破裂诊治体会

目的探讨股动脉反复注射毒品后引起股动脉假性动脉瘤破裂出血的手术治疗经验.方法对我科在1998年6月至2005年12月收治16例因经股动脉反复制注射毒品后致股动脉假性动脉瘤破裂出血行手术治疗病人的临床资料回顾性分析.结果16例均行病灶切除清创手术.其中3例行血管重建术,术后半年到一年均发生人工血管感染需手术切除人工血管.13例行股动脉结扎术,1例术后股动脉出血死亡,所有病例无一例术后发生下肢坏疽.结论应用股动脉结扎瘤体切除清创术治疗反复注射毒品引起股动脉假性动脉瘤破裂出血似乎是一种简单和安全的方法,似应作为首选的治疗措施.如术后发生肢端严重缺血时,可再考虑紧急行髂-股动脉解剖外径人工血管旁路术.     

注射海络因所致感染性假性股动脉瘤的外科治疗

目的 探讨注射海络因所致感染性假设股动脉瘤的外科治疗方法。方法 对14例注射海络因所致感染性假性股动脉瘤患者的临床资料进行回顾性分析。结果 14例患者均行手术治疗,术中见股动脉破裂口长0．5－2．0cm,皆予以瘤体切除,人工血管骼股动脉置换术,全组术后肢体供血良好,功能正常,瘤腔和创口经清创、引流和抗感染治疗后均愈合。术后2周及3个月彩超复查示移植血管通畅,未发现吻合口漏或血栓形成。结论 瘤体的彻底清创和血管重建是治疗注射海络因所致感染性假性股动脉瘤的有效方法。术后应注意瘤腔的充分引流、抗感染和抗凝治疗。     

感染性假性股动脉瘤61例治疗分析

目的 探讨动脉瘤切除和动脉结扎治疗创伤后感染性假性股动脉瘤的作用。方法回顾性分析2001年1月至2006年12月中山大学附属第一医院收治的62例因吸毒致创伤后感染性假性股动脉瘤的治疗经过。采用腹股沟韧带上方切口,经腹膜后控制髂外动脉,并在动脉瘤远端暴露股浅动脉,切除动脉瘤,局部清创和血管结扎。结果无术后死亡,无术后大出血及截肢。平均随访32个月（3个月至4年）,2例有轻度的间歇性跛行。结论 创伤后感染性假性股动脉瘤须紧急手术治疗。动脉瘤切除、动脉结扎和彻底的局部清创治疗创伤后感染性假性股动脉瘤安全、有效,且手术操作相对简单。     

Experimental studies with absorbable and nonabsorbable sutures in infected canine arterial anastomoses

Vascular anastomoses are usually performed with nonabsorbable synthetic suture material. In an infected wound suture material may have a negative effect on the healing of vascular anastomoses, leading to leakage and formation of false aneurysms. In a canine model 40 neck wounds and 40 groin wounds were contaminated with a standard suspension of Staphylococcus aureus. Subsequently 80 end-to-end anastomoses were performed in both carotid and femoral arteries with the absorbable polydioxanone (PDS) or the nonabsorbable polypropylene (PPL) suture material in one of either side. After wound infection or hemorrhage occurred, or at least 7 days to 6 months after vascular surgery, the dogs were put to death and the contaminated vessels were removed to determine the extent of infection with light and scanning electron microscopy. Macroscopic (presence of pus, anastomotic rupture, or aneurysm) and microscopic findings (absorption, tissue reaction) were compared statistically with the McNemar test. There was no difference in the incidence of wound infection between the sutures examined. Bacteriologic cultures revealed no other microorganism than the inoculated staphylococcus strain or occasional skin contaminants. In the PPL group hemorrhages occurred more frequently (n = 6) than in the PDS group (n = 2; p = 0.125). Anastomotic aneurysms (n = 5) were found only in the PPL group (p = 0.375). These differences, although statistically not significant (because of the small number of the studied anastomoses), suggest the use of monofilament absorbable suture material for autogenous anastomoses in a contaminated area.     

大动脉病变的外科手术治疗

目的　探讨大动脉病变的手术治疗方法。方法　回顾性分析 86例大动脉病变外科手术治疗的临床资料。其中胸腹主动脉瘤 3例 ;降主动脉夹层破裂并巨大假性动脉瘤形成椎骨破损 2例 ;腹主动脉局限性夹层破裂并假性动脉瘤形成 2例 ;腹主动脉瘤十二指肠空肠曲瘘并消化道大出血 1例 ;腹主动脉瘤破裂并休克 5例 ,腹主动脉外伤后破裂 3例 ;腹主动脉瘤和 /或并单或双侧髂动脉瘤2 1例 ;髂动脉瘤 6例 ;股动脉瘤 9例 ;髂或股动脉假性动脉瘤 2 1例 ;右锁骨下动脉和椎动脉起始部破裂并巨大假性动脉瘤形成 1例 ;左或右锁骨下动脉破裂并假性动脉瘤形成 3例 ;颈动脉瘤 2例 ,颈动脉假性动脉瘤 7例。行人工血管置换治疗 71例 ,自体静脉修补 3例 ,动脉破口修补术 12例。结果　术中及术后 3 0d死亡率为 3 .5 % ( 3 /86)。随访 73例 ,随访时间 1个月至 5年 ,除 1例腹主动脉瘤十二指肠瘘患者已死亡外 ,余均生存良好。结论　大动脉病变的外科手术治疗仍然是一种十分有效和经济实用的方法 ,在技巧等方面的改进有利于提高手术的成功率     

Sartorius myoplasty for deep groin wounds following vascular reconstruction

Groin wound infections following vascular reconstructive surgery prolong hospital admission and convalescence and may lead to more serious morbidity with prosthetic graft infection, false aneurysm formation, or hemorrhage. Therefore, it is imperative to achieve wound closure as expeditiously as possible. Herein, we describe 11 patients with complicated groin wounds and report our management using sartorius myoplasty. Five of these patients had underlying prosthetic grafts at risk. All patients underwent wound closure with sartorius myoplasty after adequate debridement of necrotic and infected soft tissue. Success of wound closure with complete primary healing was observed in nine patients, while in two, adequate early coverage of femoral vessels was achieved, but extended wound care for superficial skin separation was necessary with eventual complete healing. There was no morbidity or mortality related to the added surgical procedure. One patient underwent late repair of a femoral false aneurysm. There were no other complications seen after an average follow-up of 20 months (range: 6 to 49 months). In summary, we recommend that sartorius myoplasty be considered for wound infections to hasten groin closure, decrease hospital stay, and reduce the chance of infectious complications.     

Sternal osteomyelitis: use of vacuum-assisted closure device as an adjunct to definitive closure with sternectomy and muscle flap reconstruction

OBJECTIVES: Sternal osteomyelitis following cardiac surgery often requires debridement and flap coverage. The VAC (vacuum-assisted closure) device has been useful in complex wound coverage. A retrospective review of a single surgeon's experience with sternal reconstruction using the VAC device as an adjunct to debridement and muscle flap reconstruction was performed. METHODS: Thirteen consecutive patients over a 34-month period underwent debridement and reconstruction of sternal wounds. Eleven patients (85%) were males, and two (15%) were females. Mean age was 61 years (range: 43-73 years). Acute purulent sternal infections occurred in seven patients, while chronic sternal osteomyelitis was seen in six patients. Use of the VAC device during the perioperative period was evaluated. RESULTS: Of the 13 patients, the VAC device was used prior to flap closure in six patients, and after flap closure in two patients. Sternal debridement with bilateral pectoralis muscle flaps was used to reconstruct 12 patients, and one patient underwent debridement only with VAC placement. All 13 patients (100%) had complete closure of their complex wounds at an average of follow-up of 14 months. CONCLUSIONS: The VAC device is useful in the treatment of sternal osteomyelitis in three contexts: (1) as a temporary wound care technique preoperatively that minimizes dressing changes and prevents shear stresses of an open sternum, (2) as the sole method of wound closure in specific cases, and (3) as a technique to facilitate healing in postoperative flap reconstruction cases complicated by reinfection.     

Superficial femoral vein graft interposition in situ repair for femoral mycotic aneurysm

Femoral mycotic aneurysms require surgical treatment to prevent progressive sepsis and hemorrhage. Some surgeons recommend simple debridement and ligation of the femoral artery, whereas others recommend reconstruction in selected cases or all cases due to concerns about high risk of limb loss. In situ reconstruction has been discouraged due to concerns about anastomotic or graft disruption by persistent infection. However, the superficial femoral vein has been used successfully as an in situ replacement after removal of infected aortic prostheses. We present two patients with femoral mycotic aneurysms, both of whom were treated successfully with in situ reconstruction using autogenous superficial femoral vein.     

下肢动脉主干结扎治疗毒品注射所致股动脉假性动脉瘤

目的探讨注射毒品所致股动脉假性动脉瘤的合理外科治疗方式。方法对中山大学附属第一医院2001年6月至2004年5月收治的18例注射毒品所致股动脉假性动脉瘤进行分析，均行下肢动脉主干血管结扎及瘤体清创术，其中2例术后行动脉造影。术中见破裂口长约0．5～3．5cm，5例位于股浅动脉，13例位于股总动脉或股动脉分叉。结果术后无一例出现严重下肢动脉缺血，2例经动脉造影证实瘤体周围有良好的侧支循环。结论血管结扎并瘤体切除是治疗吸毒性股动脉假性动脉瘤的合理手术方式。     

注射毒品所致假性股动脉瘤的外科治疗（附12例病例分析）

目的探讨注射毒品所致假性股动脉瘤外科治疗的手术方式和疗效。方法对12例注射毒品所致假性股动脉瘤病人的临床资料进行回顾性分析。12例病人均接受手术治疗，瘤体切除并清创后，其中8例行股动脉结扎术，均为急性出血病人，4例采用ePTFE人造血管行髂外动脉和股浅动脉端端吻合术。结果术后10d及3个月复查彩色多普勒超声显示人造血管血流通畅，以及评估患肢有无缺血、坏死。结论：彻底清创、股动脉结扎及必要时的血管重建是对注射毒品所致假性股动脉瘤外科治疗的有效方法。     

True profunda femoris aneurysms: Are they more dangerous than other atherosclerotic aneurysms of the femoropopliteal segment?

Three cases of true aneurysms of the profunda femoris artery are reported along with a review of 17 other cases in the literature. These aneurysms are rare and commonly present with rapid enlargement or rupture (9/20), the risk of rupture being higher than those affecting the femoral or popliteal arteries. All patients underwent successful surgical treatment except for one who required amputation. The diagnosis of an aneurysm of the profunda femoris artery must be considered in all patients with a pulsatile swelling in the groin. Surgical treatment is mandatory, and it carries a low mortality as well as a low risk of amputation.