对感染性腹主动脉瘤治疗的再认识

Recognition of the treatment of infected abdominal aortic aneurysm

感染性腹主动脉瘤(IAAA)是临床灾难性疾病,治疗困难,病死率高。手术治疗的目标是清除病灶、防止瘤体的破裂以及保持血流通道。尽早足疗程抗生素的使用是治疗的基础,包括原位重建及腋股旁路术的传统外科手术符合外科治疗原则,但清除感染病灶后的原位重建术后移植物感染率较高,腋股旁路术后有可能出现移植物阻塞及主动脉残端破裂等严重并发症。腔内治疗与外科处理原则不尽相符,但临床现有的资料证实高龄不能耐受开放手术的病例仍然适用。后腹膜旁路术能有效减少移植物感染并保持移植物通畅,是较合理的IAAA的手术方式。

Infected abdominal aortic aneurysm(IAAA)is a catastrophic disease,which is difficult to treat and has a high mortality rate.The goal of surgical treatment is to eliminate the lesion,prevent rupture of the aneurysm and maintain the channels of blood flow.The early and full course of antibiotic medications is the basis of treatment.The traditional surgical procedures that include the in situ prosthetic reconstruction and axillofemoral bypass are consistent with surgical principles.However,the graft infection rate is relatively high after debridement and in situ prosthetic reconstruction,and serious complications such as graft obstruction or aortic stump rupture may occur after axillofemoral bypass operation.Although endovascular procedures are not entirely consistent with surgical principles,the available clinical data suggest that they are still applicable in elderly patients who are unable to tolerate open surgery.Retroperitoneal bypass can effectively reduce graft infection and maintain graft patency,so it is a more rational surgical procedure for IAAA.