注射毒品致股动脉感染性假性动脉瘤的外科治疗

目的：探讨注射毒品致股动脉感染性假性动脉瘤的外科治疗。方法：回顾性分析因注射毒品致股动脉感染性假性动脉瘤患者63例的临床资料。结果：假性动脉瘤破裂52例，住院期间再次或多次出血者26例。行髂外动脉—股浅动脉旁路带环人工血管重建术49例，行髂外动脉或股动脉结扎术14例。围手术期无死亡。1例住院期间出现移植物感染，5例随诊期间出现移植物感染，感染的移植物取出后同时行髂外动脉或股动脉结扎保肢成功。1例行股动脉结扎患者术后出现肢体坏死行大腿截肢。其余手术患者均恢复良好。36例复诊彩超检查示人工血管通畅。结论：尽早外科手术是抢救因注射毒品致感染性假性动脉瘤患者生命的唯一途径；彻底清创引流、髂外动脉—股浅动脉旁路带环人工血管重建以及控制感染是治疗的有效方法；在感染严重且局部条件无法重建血管的情况下，结扎髂外动脉或股动脉也是一种救治患者的可行选择。

Surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection

Objective To investigate the surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection.Methods The clinical data of 63 cases of infected pseudoaneurysms of femoral artery caused by narcotics injection were reviewed retrospectively.Results The tumors in 52 cases ruptured. Rupture hemorrhoea first occurred in 45 patients before admission and in 7 during hospitalization. Twenty-six patients suffered from recurrent or multiple hemorrhoea while in hospital. Forty-nine patients received external iliac artery-superficial femoral artery extra-anatomic bypass reconstruction with banded vascular grafts and the other 14 received ligation operations of the external iliac artery or the femoral artery. No one died in the perioperative period. One patient with vascular graft reconstruction developed graft infection during hospitalization and 5 developed graft infection during the follow-up. No ischemic necrosis occurred in the affected limbs after the infected vascular grafts were removed. One patient developed necrosis in the affected limb after the femoral artery was ligated and then above-knee amputation was performed. The others recovered well. Unobstructed blood circulation in the vascular graft was exhibited by color Doppler ultrasonography in 36 cases during the follow-up. Conclusion Operation as early as possible is the only way to rescue patients' lives threatened by infected pseudoaneurysms of femoral artery caused by narcotics injection. Thorough debridement and drainage, revascularization between external iliac artery and superficial femoral artery using band artificial blood vessel, and controlling infection are therapeutic modus operandi. Ligation of external iliac artery or femoral artery is also a feasible measure to rescue patients' lives when pseudoaneurysms are infected severely.