感染性腹主动脉瘤的诊治经验

目的总结感染性腹主动脉瘤(infected abdominal aortic aneurysm,IAAA)的诊治经验。方法回顾性分析2010年7月至2018年12月哈尔滨医科大学附属第一医院血管外科收治的10例IAAA患者的临床资料。结果 5例动脉瘤破裂行急诊手术(4例腔内手术、1例开放手术),5例择期手术。6例细菌培养阳性,4例阴性。3例开放手术患者均为原位血管重建,其中1例术后26 d死于腹主动脉消化道瘘,术后1年生存率为66.7%(2/3)。5例腔内修复患者围术期无死亡。随访期内死亡2例,术后1年生存率为60.0%(3/5)。2例复合手术患者围术期和随访期均无死亡和严重并发症发生,术后1年生存率为100.0%(2/2)。结论 IAAA治疗的关键在于控制感染、手术时机把握以及动脉重建方式的选择,临床工作中应根据患者的具体情况选择最佳的治疗方案。

Diagnosis and treatment of infected abdominal aortic aneurysm

Objective To summarize the experience of diagnosis and treatment of infected abdominal aortic aneurysms(IAAA).Methods The clinical data of 10 patients with IAAA in the First Affiliated Hospital of Harbin Medical University from July 2010 to December 2018 were analyzed retrospectively.Results Five patients underwent emergency surgery(four cases underwent endovascular repair and 1 case underwent open operation)for aneurysm rupture,and five underwent selective surgery.Six cases were positive while four were negative in the bacterial culture.Three patients with open operation underwent in situ vascular reconstruction One patient died of aortoenteric fistula 26 days after the operation.The 1-year survival rate was 66.7%(2/3).There was no death in the five patients with endovascular repair during the perioperative period.Two patients died during the follow-up period,and the 1-year survival rate was 60.0%(3/5).There were no deaths and serious complications in the two patients with hybrid surgery during the perioperative period and follow-up period,and the 1-year survival rate was 100.0%(2/2).Conclusion The key of treatment for IAAA are control infection,surgical timing and the choice of the ways of artery reconstruction.We should make the best decisions quickly,choose the best treatment plan according to the specific circumstances of patients.