人造血管旁路术后移植物感染的外科治疗

Surgical management of patients with infected vascular prostheses

为评价人造血管旁路术后移植物感染外科治疗的临床疗效，作者对１９８５年～１９９５年上海中山医院收诊的２５０例人造血管旁路术后发生移植物感染的８例进行分析。临床表现为移植物外露伴创口溢脓、大出血、移植物和／或远端肢体动脉搏动消失、远端肢体坏疽。移植物感染率３．２％。外科治疗包括：（１）移植物去除、清创引流术；（２）移植物去除、清创引流加截肢术；（３）移植物去除、清创引流加近远端动脉人造血管重建术；（４）单纯清创引流术。结果显示，８例中６例痊愈，２例因吻合口破裂出血死亡。作者认为移植物感染的危险因素有：（１）糖尿病；（２）继发血肿；（３）同一部位多次手术。外科积极处理较保守治疗愈后更好。

We evaluated the therapeutic efficacy of surgical management of patients with infected vascular prostheses.Eight cases of infected vascular prosthetic grafts from 250 prosthetic bypasses were reviewed.The rate of graft infection was 3.2%.Clinical manifestations were localized wound infection with prosthetic graft exposure, anastomotic hemorrhage and gangrene in lower extremity.Treatment included graft removal and debridement;graft removal and primary amputation;graft removal and revascularization;debridement and local graft irrigation. Two cases died from anastomotic hemorrhage and the others recovered.The predisposing factors of vascular prosthetic infection are diabetes mellitus, secondary hemotoma and reoperation in the same position. Conservative treatment efforts without revascularization justifies a more aggressive approach to suspected graft infection.