感染性人工血管动静脉内瘘的手术治疗：完全切除与部分切除人工血管的比较
Surgical treatment of infected prosthetic dialysis arteriovenous grafts: total versus partial graft excision.
作者信息
Schutte Warren P, Helmer Stephen D, Salazar Luis, Smith John L
机构信息
Department of Surgery, University of Kansas School of Medicine-Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA.
出版信息
Am J Surg. 2007 Mar;193(3):385-8; discussion 388. doi: 10.1016/j.amjsurg.2006.09.028.
BACKGROUND
Thirty-five percent of hemodialysis patients with polytetrafluoroethylene grafts lose their access secondary to infection. We hypothesized that partial graft excision (PGE) for infection increases the incidence of vascular anastomotic complications when compared with total graft excision (TGE).
METHODS
The medical records of hemodialysis patients with a polytetrafluoroethylene graft infection from 1994 through 2004 were reviewed for PGE or TGE surgeries.
RESULTS
A total of 111 infected grafts were managed surgically in 90 patients: 91 grafts by PGE and 20 grafts by TGE. Complication rates were 26.4% versus 5% in the PGE and TGE groups, respectively (P = .038). The incidence of hemorrhage and graft-associated systemic sepsis was similar, whereas the incidence of local infection was increased in the PGE group (19.8% vs. 0%, P = .030).
CONCLUSIONS
Because potential access sites are limited, using PGE to salvage a site, even with a known increased incidence of local infection, represents an acceptable method for the treatment of graft infection.
背景
35%的聚四氟乙烯移植物透析患者因感染失去通路。我们假设，与完全切除移植物（TGE）相比，因感染进行部分移植物切除（PGE）会增加血管吻合并发症的发生率。
方法
回顾了1994年至2004年因聚四氟乙烯移植物感染而行PGE或TGE手术的血液透析患者的病历。
结果
90例患者共111个感染移植物接受了手术治疗：91个移植物行PGE，20个移植物行TGE。PGE组和TGE组的并发症发生率分别为26.4%和5%（P = 0.038）。出血和移植物相关全身脓毒症的发生率相似，而PGE组局部感染的发生率增加（19.8%对0%，P = 0.030）。
结论
由于潜在的通路部位有限，即使已知局部感染发生率增加，使用PGE挽救一个部位仍是治疗移植物感染的可接受方法。
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