Inafuku Hitoshi, Senaha Shigenobu, Morishima Yuji, Nagano Takaaki, Arakaki Katsuya, Yamashiro Satoshi, Kuniyoshi Yukio
Thoracic and Cardiovascular Surgery, Division Department of Bioregulatory Medicine, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan.
Ann Thorac Cardiovasc Surg. 2008 Jun;14(3):196-9.
We present four cases of infected thoracoabdominal aortic aneurysm (TAAA), including abdominal branches that underwent surgical repair. The mean age of patients at the time of operation was 61+/-18 (range: 39-83) years. The extent of the aneurysm was Crawford type III in 1 case and type IV in the other 3. They all underwent an emergency or urgent operation, which consisted of a debridement of the infected tissue, in situ four-branched Dacron graft replacement, and iodine gauze packing for 48 h followed by omental wrapping of the graft. To prevent postoperative spinal ischemia, intercostal and lumbar arteries were reimplanted under motor-evoked potential (1.25 pairs per patient). There was one (25%) hospital death, but postoperative graft infection did not occur in these present cases during a mean follow-up period of 15+/-43 (1-96) months. Antibiotics were administered intravenously for 8 weeks after the operation, then continued orally for a lifelong period. Postoperatively, paraplegia occurred in one (25%) patient. Our strategy for infected TAAA including major abdominal branches may prevent postoperative graft infection.
我们报告了4例感染性胸腹主动脉瘤（TAAA）病例，包括接受手术修复的腹部分支。手术时患者的平均年龄为61±18岁（范围：39 - 83岁）。动脉瘤范围为Crawford III型1例，IV型3例。他们均接受了急诊或限期手术，包括感染组织清创、原位四分支涤纶人工血管置换，碘仿纱条填塞48小时，随后大网膜包裹人工血管。为预防术后脊髓缺血，在运动诱发电位监测下进行肋间动脉和腰动脉再植（每位患者平均1.25对）。有1例（25%）医院死亡，但在平均15±43（1 - 96）个月的随访期内，这些病例未发生术后人工血管感染。术后静脉应用抗生素8周，然后终身口服。术后有1例（25%）患者发生截瘫。我们针对包括主要腹部分支的感染性TAAA的治疗策略可能预防术后人工血管感染。
