解剖外旁路治疗注射毒品所致股动脉感染性假性动脉瘤

目的总结解剖外旁路治疗注射毒品所致股动脉感染性假性动脉瘤的外科治疗经验。方法回顾性分析我院2000年1月至2009年12月期间31例因注射毒品引起的股动脉感染性假性动脉瘤并接受解剖外旁路手术的患者临床资料,对破口部位、瘤体大小、手术方式以及疗效进行比较。结果 22例行倒置自体大隐静脉解剖外旁路手术,9例行ePTFE人造血管解剖外旁路手术。术后平均随访时间(7.6±5.8)个月,最长15个月。接受自体大隐静脉旁路的病人未出现移植物感染,1年内肢体存活率100%,1年内移植物通畅率86.4%(19/22),3例因复吸导致移植物阻塞(14.6%)。接受人造血管旁路的病人中,5例在术后1周内出现移植物感染(55.6%)而切除移植物(其中2例随后出现肢体严重缺血而行截肢术),1年内肢体存活率77.8%,3例术后3个月内移植物阻塞,1例术后1年移植物仍然通畅(通畅率11.1%)。结论倒置自体大隐静脉解剖外旁路手术是治疗注射毒品所致股动脉感染性假性动脉瘤的安全、有效、经济的方法。

Objective To explore the outcomes of extra-anatomic bypass in the treatment of infected femoral artery pseudoaneurysms caused by drug injection.Methods Data of 31 patients with infected femoral artery pseudoaneurysms caused by drug injection who received extra-anatomic bypasses in our hospital from January 2000 to June 2009 were collected.The outcomes of two kinds of grafts,autologous great saphenous vein and ePTFE prosthesis were compared.Results 22 patients received autologous great saphenous vein bypasses while 9 cases received ePTFE grafts.The patients were followed for 1 to 15 months（7.6±5.8 mon）.All the patients with autologous vein grafts were free of infection,while 5 ePTFE prostheses emerged severe graft infection within 7 days after operation which were forced to be removed.Rates of infection in the two groups were 0 vs 55.6%（P0.001）.1 year after operation,all the limbs involved in the group of vein graft survived,while 2 patients in the prosthesis graft group were compelled to receive amputation（Because of severe limb ischemia after removal of the graft for uncontrollable graft infection.）.Limb surviving rates were 100%（vein graft group） vs 77.8%（prosthesis group）（P0.01）.19（86.4%） of the vein grafts remained patent 1 year later（3 cases were occluded because of re-injection） while only 1（11.1%） patent prosthesis bypass was reserved（P0.01）.Conclusion Extra-anatomic bypass was superior to ePTFE prosthesis in the treatment of infected pseudoaneurysms in femoral artery caused by drug injection.