Rubin J R, Malone J M, Goldstone J
J Vasc Surg. 1985 Jan;2(1):92-8.
No experimental data have been published that evaluate the role of lower extremity lymphatics in the pathophysiology of arterial graft infection. Bilateral interpositional femoral artery graft (PTFE) replacements were performed in 21 greyhounds, accompanied by unilateral limb ischemia-rendering operations and ipsilateral bacterial inoculations with standardized inocula of Escherichia coli and Staphylococcus aureus. Inguinal lymphatics in the ischemic leg were either simply transected (group I), carefully preserved (group II), or excised and ligated (group III) at the time of femoral graft implantation. The grafts were harvested 48 hours later and graft and blood cultures obtained. There was an 87.5% incidence of positive graft cultures in groups I and II, but both organisms were cultured significantly more often in group II than in group I (62.5% vs. 12.5%; p less than 0.01). Blood culture data were similar. The incidence of positive graft and blood cultures in group III was only 20%, and no cultures obtained were positive for both organisms. Cultures of contralateral control grafts yielded both organisms in all group II dogs compared with only 25% of group I and 0% in group III (p less than 0.01). These results suggest that the lymphatics probably contribute to the development of acute graft infection by absorbing bacteria, and either transporting them to the systemic circulation via lymphatic-venous communications when the lymphatics are intact, causing hematogenous contamination of a graft, or by directly bathing the implanted graft when the lymphatics are disrupted proximal to a septic focus. Careful isolation, transection, and ligation of the inguinal lymphatics at the time of arterial reconstruction might minimize acute graft sepsis.
尚未有评估下肢淋巴管在动脉移植感染病理生理学中作用的实验数据发表。对21只灵缇犬进行双侧股动脉间置移植（聚四氟乙烯），同时进行单侧肢体缺血性手术，并对同侧接种标准化的大肠杆菌和金黄色葡萄球菌接种物。在植入股动脉移植物时，对缺血腿的腹股沟淋巴管进行简单横断（I组）、小心保留（II组）或切除并结扎（III组）。48小时后取出移植物，并进行移植物和血培养。I组和II组移植物培养阳性率为87.5%，但II组两种细菌培养阳性率均显著高于I组（62.5%对12.5%；p<0.01）。血培养数据相似。III组移植物和血培养阳性率仅为20%，且未获得两种细菌均为阳性的培养结果。与I组的25%和III组的0%相比，II组所有犬的对侧对照移植物培养均获得两种细菌（p<0.01）。这些结果表明，淋巴管可能通过吸收细菌促进急性移植物感染的发生，当淋巴管完整时，通过淋巴-静脉交通将细菌转运至体循环，导致移植物血源性污染，或者当淋巴管在感染灶近端中断时，直接浸润植入的移植物。在动脉重建时小心分离、横断和结扎腹股沟淋巴管可能会使急性移植物败血症降至最低。
