感染性股动脉假性动脉瘤手术治疗及伤口处理:附16例分析

Surgical treatment and wound management of femoral artery infected false aneurysms: an analysis of 16 cases

目的:探讨感染性股动脉假性动脉瘤治疗的手术方式,以及评估封闭负压辅助闭合(VAC)装置在治疗感染伤口的作用和应用价值。方法:回顾性分析2015年7月—2018年4月行手术治疗的16例感染性股动脉假性动脉瘤患者的临床资料。结果:16例患者术中破损动脉直接缝合破口5例,自体静脉修补6例,自体静脉置换3例,2例行动脉瘤切除局部旷置。患者手术伤口术后均经VAC装置引流治疗;伤口二期直接缝合12例,行皮瓣移植4例,伤口愈合时间平均34.2 d。术后13例患者获随访6个月,除1例伤口再次破溃接受清创治疗之外,其余12例患者伤口均无再次感染或破溃,所有随访患者动脉瘤均未复发。结论:感染性股动脉假性动脉瘤应尽早手术清创治疗;VAC装置治疗感染性伤口安全、有效。

Objective: To investigate the surgical methods for the treatment of femoral artery infected false aneurysm and evaluate the therapeutic effect and application value of using vacuum-assisted closure (VAC) device in infected wound management.Methods: The clinical data of 16 patients with femoral artery infected false aneurysms and underwent surgical treatment from July 2015 to April 2018 were retrospectively analyzed.Results: Of the 16 patients, 5 cases underwent direct suture of the vascular breach, 6 cases underwent wound repair with autogenous vein, 3 cases underwent autogenous vein replacement, and the other 2 cases received aneurysm resection and local exclusion. All patients underwent drainage of the infected wounds with VAC device. Twelve patients healed after second stage suture, and 4 cases received skin flap transplantation, with an average wound healing time of 34.2 d. Follow-up for 6 months was obtained in 13 patients, and except one patient who had a wound rupture and received debridement, no wound reinfection or rupture occurred in any of the remaining 12 patients, and no relapse of arterial false aneurysm occurred in any of the patients followed up.Conclusion: For femoral artery infected false aneurysms, surgical treatment with debridement should be performed as early as possible. VAC device is safe and effective in management of the infected wounds.