感染性腹主动脉瘤的外科治疗及并发症分析

目的探讨感染性腹主动脉瘤的外科治疗策略,并对术后并发症进行分析。方法回顾性分析2009年11月—2012年12月血管外科收住入院并行外科干预的4例感染性腹主动脉瘤的临床资料。结果 4例均因发热并腰部或腹部疼痛入院,根据计算机断层X线血管造影(CTA)、血培养和白细胞升高等,确诊为感染性腹主动脉瘤。2例采用外科手术,2例采用腔内修复术。外科手术组1例术后发生多器官功能衰竭于术后4 d死亡,腔内修复组无围手术期死亡及并发症发生。3例存活者中位随访时间为15个月,其中1例腔内治疗15个月后因发生消化道大出血死亡。本组共死亡2例,病死率为50%。结论感染性腹主动脉瘤治疗方案尚不完善,腔内修复术近期疗效满意,为高危患者提供了一种相对安全、简便的术式选择,但需密切随访。今后还需进行更多的相关研究和长期随访以提高诊治水平。

Analysis of Surgical Therapy and Complications of Infected Abdominal Aortic Aneurysm

Objective To investigate the surgical therapy strategies of infected abdominal aortic aneurysm and to ana- lyze its postoperative complications. Methods Clinical data of 4 inpatients with infected abdominal aortic aneurysm who had undergone surgical intervention between November 2009 and December 2012 was retrospectively analyzed. Results Four pa- tients visited doctors for fever and pain in the waist or abdomen, and were diagnosed as having infected abdominal aortic aneu- rysm according to results of the spiral CT angiography （CTA） , blood culture and leukocytosis. Two patients underwent surger- ies, and two patients underwent endovascular repair. One patient died of postoperative multiple organ failure 4 d after the sur- gery, and the two patients undergoing endovascular repair survived with no complications during the perioperative period. Mid- die follow-up time of the 3 survivors was 15 months, among whom one patient died of massive hemorrhage of the gastrointesti- nal tract after the endovascular repair during the follow-up time. Two patients died, and the fatality rate was 50%. Conclu- sion Treatments of infected abdominal aortic aneurysm still need to be improved. Endovascular repair for high risk patients with infected abdominal aortic aneurysm is feasible and simple, but the patients need to be closely followed up. Levels of diag- nosis and treatment can be improved by further study and research and long term follow-up.