治疗注射吸毒所致股动脉假性动脉瘤手术方法的选择

Selection of surgical managements in infected femoral artery pseudoaneurysms caused by drug injection

目的：探讨治疗注射吸毒所致股动脉假性动脉瘤手术方法的选择及临床疗效。方法回顾性分析东莞市人民医院2001年1月至2014年12月手术治疗因注射吸毒所致股动脉假性动脉瘤患者61例，经彻底清创＋假性动脉瘤切除后，分别采用股动脉修补或股动脉端端吻合术（8例）、人工血管重建术（34例）及股动脉结扎术（19例）三种手术方法进行处理，部分患者进行6个月~3年随访。结果所有患者均顺利完成手术，无手术死亡病例。术后早期，有5例行股动脉修补术或股动脉端端吻合术患者出现股动脉修补或股动脉端端吻合处感染、破裂出血再次手术；3例行人工血管重建术患者因吻合口出血再次手术；1例行股动脉结扎术患者术后因下肢明显缺血急诊行人工血管重建术。随访期间，2例行股动脉结扎术患者出现间歇性跛行，5例行股动脉人工血管重建术患者经人工血管穿刺注射形成假性动脉瘤再次手术。结论外科手术是治疗注射吸毒所致股动脉假性动脉瘤的有效方法，股动脉修补术或股动脉端端吻合术效果不确定，再次感染破裂手术率较高，股动脉人工血管重建术和股动脉结扎术效果良好，但各有利弊，需要根据吸毒患者综合情况进行选择。

Objective To investigate the surgical management and clinical effect of infected femoral artery pseudoaneurysms caused by drug injection. Methods The data on surgical treatment of 61 patients with infected femoral artery pseudoaneurysm admitted from January 2001 to December 2014 were analyzed retrospectively. All the patients underwent operative treatment inclu-ding excision of infected femoral artery pseudoaneurysm and exhaustive debridement. The surgical procedures included：8 cases underwent repair or anastomosis of femoral artery,34 cases received prosthetic vascular bypass（21 cases through lateral tunnel and 13 cases through FP cavity）,19 cases received transfixion with proximal external iliac artery and distal superficial and deep femoral artery. A part of patients were followed up from 6 months to 3 years after operation. Results All of the operations were successful and no patient died in hospital. In the early postoperative period,5 cases of repair or anastomosis of femoral artery and 3 cases who received prosthetic vascular bypass arised infection and bleeding,acute ischemia in the lower extremities occurred af-ter operation in 1 case who received transfixion with femoral artery. Those patients had to be operated again. In the follow up, one of 19 cases occurred intermittent claudication after artery transfixion;infected femoral artery pseudoaneurysm recurred in 2 cases because of intravenous drug abuse through prosthetic vascular again. Conclusion Operation as early as possible is the ef-fective way to rescue patients’lives threatened by infected pseudoaneurysms of femoral artery caused by drug injection. The effect of repair or anastomosis of femoral artery are not sure,the incidence of re-operation is high. Prosthetic vascular bypass and trans-fixion with femoral artery are also advisable,but the effect of the two treatments varies with the individual.