血流重建术及动脉结扎术治疗慢性感染性股部动脉假性动脉瘤的疗效比较

Comparison between flow reconstruction and vascular ligation for chronic infected false aneurysms of femoral artery

目的探讨毒品注射所致的慢性感染性股部动脉假性动脉瘤（CIFA）的合理外科治疗方法。方法对我院血管外科2007年7月至2010年6月收治的44例CIFA患者按住院号单双号分组，单号为第一组（20例）行主干动脉血流重建术，双号为第二组（24例）行主干动脉结扎术。结果第一组14例（70％）术后无任何并发症。6例（30％）术后出现严重感染．取出移植物后行二期血流重建术；第二组20例（83．3％）术后无任何并发症，4例（16．7％）出现间歇性跛行因而行二期血流重建术。所有患者行一期或二期手术后均康复出院，无一例患者行截肢术。两组最终手术成功率差异无统计学意义（P〉0．05），但第二组一期手术成功率显著高于第一组（P〈0．05），第二组出现严重并发症并行二期血流重建的病例显著低于第一组（P〈0．05）。随访5个月至3年，所有患者均未出现间歇性跛行等缺血性症状及患肢缺血性坏死等严重并发症。结论主干动脉结扎术是CIFA的合理手术方式，必要时可行二期血流重建术。

Objective To compare the efficacy of flow reconstruction versus vascular ligation as a surgical management of chronic infected false aneurysm （ CIFA ） of femoral artery caused by drug abuse. Methods Forty - four patients with CIFA of femoral artery treated in our hospital from July 2007 to June 2010 were randomized into two groups by an odd or even, admission number. There were 20 patients with an odd number in the first group and 24 patients with an even number in the second group. The patients of the first group underwent flow reconstruction with a vein graft or vein patch angioplasty and the patients of the second group underwent vascular ligation. Results In the first group 14 （70%）patients did not have any complications,but 6 （30%） patients had severe infection and the grants were taken out and they received second flow reconstruction. In the second group 20 （83.3%）recovered without any complications, but 4 patients had intermittent elaudication and received second flow reconstruction. All patients receiving one - stage or two - stage operation recovered completely and no one received amputation. The final surgical results of two groups had no statistically significant difference（ P 〉 0.05 ）, but the success rate of one - stage operation of the second group was higher than that of the first group（P 〈 0.05 ）. The rate of serious complications followed by two - stage operation of the second group was lower than that of the first group（ P 〈 0.05）. During a follow - up period of 5 months to 36 months,no patient had serious complications of intermittent claudication or avascular necrosis of limb. Conclusion To patients with CIFA of femoral artery, vascular ligation is a reasonable treatment, and flow reconstruction in two - stage operation can be done if necessary.