注射毒品致股动脉感染性假性动脉瘤破裂出血的手术治疗

Surgical treatment for rupture and hemorrhage of infected femoral artery pseudoaneurysm caused by drug injection

目的探讨治疗注射毒品导致的股动脉感染性假性动脉瘤破裂出血的手术方法。方法对17例注射毒品导致的股动脉感染性假性动脉瘤破裂出血患者进行急诊手术治疗;手术采用垂直于腹股沟的纵向切口暴露近端髂外血管,试验性地夹闭髂外动脉后,应用多普勒血流探测仪扫描观察足部动脉血流信号;14例可测到血流信号的患者采用单纯结扎股动脉和切除动脉瘤的手术方法,3例未测到血流信号的患者采用切除动脉瘤血管重建手术治疗,其中1例采用股-股动脉自体大隐静脉原位移植术,另2例采用髂-股动脉人工血管旁路转流术。结果 17例患者均成功进行了感染性假性动脉瘤的扩创和切除,10例切口一期愈合,6例切口二期缝合后愈合,1例切口未缝合,经换药2个月后创面愈合,平均住院时间(21.0±4.5)d。出院时患者白细胞计数和中性粒细胞比例显著低于术前(P<0.05);3例血管重建患者手术后患肢末梢血氧饱和度显著高于手术前(P<0.05),术后3周超声检查显示移植血管血流通畅。所有病例平均随访(10.2±2.6)个月,未出现截肢和死亡病例,10例患者出现轻度的间歇性跛行,均在1 a内恢复;所有患者下肢行走功能基本恢复。结论选择性血管重建手术治疗注射毒品所致的股动脉感染性假性动脉瘤破裂出血安全可靠,术中夹闭髂外动脉或股动脉检测足背动脉或胫后动脉的血流信号,可判定是否需要重建血管。对大多数注射毒品时间超过1 a的患者,单纯的动脉结扎手术是安全可行的。

Objective To explore the surgical treatment for rupture and hemorrhage of infected femoral artery pseudoa- neurysms（IFAP） caused by drug injection. Methods A total of 17 patients with rupture and hemorrhage of IFAP caused by drug injection were treated with emergency operation. The proximate external iliac artery was exposed by making a incision per- pendicular to the groin, after the external iliac artery was clamping tentatively, the blood flow signals of pedal artery were ob- served by Doppler flow detector. Fourteen patients with blood flow signals of pedal artery were treated with simple femoral artery ligation and aneurysm excision. Three patients without blood flow signals of pedal artery were treated with aneurysm excision and reconstructive vascular operation. Among the three cases, one case was treated with autogenous saphenous vein grafting in situ,the other two cases were treated with iliofemoral vascular prosthesis bypass grafting. Results A total of 17 patients were successfully performed with debridement and excision of IFAP,the incisions in 10 cases were primary healing,the incisions in 6 cases were per seeunda intentionem, the unstitched incisions in 1 case healed by changing dressings 2 months later, the aver- age stay was（21.0 ±4.5 ）days. The leucocyte count and neutrophil ratio at the moment of leaving hospital were significantly lower than those before operation （ P 〈0. 05 ）. The peripheral saturation of blood oxygen of affected extremity in the 3 cases with vascular reconstruction after operation was significantly higher than that before operation（ P 〈0.05 ） ;3 weeks after operation, the ultrasound examination showed that the grafts were smooth. All of the patients were followed-up for（ 10.2 ± 2.6 ）months, there was no amputation and death, 10 patients with mild intermittent elaudication recovered within 1 year;the basic walking function in all patients were restored. Conclusions Selective vascular reconstruction operation for rupture and hemorrhage of IFAP caused by drug injection is safe and reliable;clamping the external iliac artery or femoral artery to detect the blood flow of arteria dorsalis pedis or arteria tibialis posterior during the operation can determine whether the patient needs to rebuild blood vessels or not. The simple artery ligation is safe and feasible for the most patients with more than 1 year drug injection.