猪霍乱沙门菌所致人感染性动脉瘤的腔内治疗

Endovascular therapy of aneurysm caused by Salmonella infection

目的评价猪霍乱沙门菌所致人感染性动脉瘤的诊断治疗方法。方法回顾性分析2000年1月至2008年12月收治的8例猪霍乱沙门菌感染性动脉瘤的诊断治疗方法及效果。结果感染性腹主动脉瘤6例，胸主动脉瘤和胭动脉瘤各1例，均行人工血管内支架腔内修复术；放置直型人工血管内支架6例，分叉型人工血管内支架2例，手术成功率为100％，无围手术期30d内死亡或并发症发生；所有患者均恢复满意，出院后口服抗菌药物，随访时间15～36个月，4例疗效满意，影像学及实验室检查无感染复发征象，3例感染复发行局部感染灶清创引流后痊愈，1例术后3个月因腹主动脉瘤破裂死亡。结论猪霍乱沙门菌是侵袭性和毒力较强的菌株，对于猪霍乱沙门菌感染性动脉瘤，腔内修复、应用抗菌素并密切随访，是一种可供选择的治疗方式。

Objective To analyze the diagnostic procedures and treatment strategies in the mycotic aneurysm caused by Salmonella enterica serotype choleraesuis infection in a single medical center. Methods From January 2000 to December 2008, clinical data of 8 cases with infected aneurysm caused by Salmonella enterica serotype choleraesuis were analyzed. Results All cases were treated with endovaseular stent-graft treatment, including abdominal aortic aneurysm in six cases, thoracic aortic aneurysm in one, and popliteal artery aneurysm in one ease. Six bifurcated stent-graft and two tube stent-graft were used. The surgical success rate was 100% with no perioperative or 30-day mortality nor major morbidity. All of the patients recovered uneventfully and were discharged with oral antibacterial agents. During mid-term follow up （range 15 -36 months） , four patients are alive and well with no signs of persistent or recurrent infection, three cases with recurrent infection were cured by drainage of local abscess and debridement, one case died of rupture of the abdominal aortic aneurysm. Conclusion Endovaseular grafting combined with antibiotic therapy and careful surveillance program represent an alternative to conventional surgery in mycotic aneurysms caused by Salmonella enterica serotype choleraesuis.