Yamada Makoto, Takeuchi Susumu, Shiojiri Yasuhiro, Maruta Kazuto, Oki Atsuyoshi, Iyano Katsuyoshi, Takaba Toshihiro
The First Department of Surgery, Showa University, Tokyo, Japan.
Ann Thorac Surg. 2002 Nov;74(5):1494-9; discussion 1499. doi: 10.1016/s0003-4975(02)03949-8.
In the treatment of pacemaker pocket infection, removal of the entire pacing system has been considered necessary to avoid recurrent infection. We report a series of patients treated surgically by our lead-preserving procedures.
Between 1990 and 2001, a total of 18 patients underwent one of two types of lead-preserving procedures. Procedure 1 preserves the full length of the lead, and procedure 2 preserves only the distal part of the lead. Signs of bacteremia, endocarditis, or purulent material within the lead insulation preclude application of these procedures in patients with potential or definite pacemaker pocket infection.
Seventeen patients who met the indications for our procedures were discharged 7 to 14 days (8.9 +/- 2.4 days, mean +/- SD) postoperatively without signs of infection and were followed up for a total of 987 patient-months until the close of the study or death without recurrent infection. The remaining 1 patient, who did not meet the indications, suffered reinfection soon after the operation.
The follow-up data suggest that our lead-preserving procedures should be considered as alternatives to conventional removal of the entire pacing system in cases of pocket infection that meet specific criteria.
在起搏器囊袋感染的治疗中，人们认为有必要移除整个起搏系统以避免反复感染。我们报告了一系列通过保留导线手术进行治疗的患者。
1990年至2001年间，共有18例患者接受了两种保留导线手术中的一种。手术1保留导线全长，手术2仅保留导线远端部分。对于有潜在或明确起搏器囊袋感染的患者，若存在菌血症、心内膜炎迹象或导线绝缘层内有脓性物质，则不能应用这些手术。
17例符合我们手术指征的患者术后7至14天（平均8.9±2.4天）出院，无感染迹象，在研究结束或死亡前共接受了987个患者月的随访，无反复感染。其余1例不符合指征的患者术后不久即再次感染。
随访数据表明，对于符合特定标准的囊袋感染病例，我们的保留导线手术应被视为传统的移除整个起搏系统手术的替代方法。
