Bonelli U, Cerruti R, Baglietto F, Cantello C, Zinicola N
Divisione di Chirurgia Vascolare, Ospedale Santa Corona, Pietra Ligure, Savona.
Minerva Chir. 1994 Sep;49(9):807-11.
The incidence of prosthesis infection in the groin ranges between 1 and 3%, with high morbidity and mortality rates. Contamination, irrespective of whether it is endogenous or exogenous, may occur during surgery of afterwards due to a secondary bacterial load which is often associated with a traumatic surgical technique for tissues, often in emergency surgery or re-operations. MATERIALS AND METHODS. Over the past 5 years a total of 410 prosthetic alloplastic grafts have been made by our Division of Vascular Surgery with at least one anastomosis at an inguinal level. The materials used for prosthesis were dacron and PTFE. Thirty-one infections were observed in the groin of which 11 involved the prosthesis and 20 were apparently restricted to the superficial and deep layer of the dermis. A cell culture test and antibiogram was always performed. Surgical or medical therapy (loco-regional + general) was used according to individual cases. RESULTS. With regard to the 11 patients with manifest infections of the prosthesis, only trans-obturator bypass surgery gave positive long-term results, whereas other operations (femoro-femoral bypass, axillo-popliteal bypass) were not satisfactory. Of the other 20 patients treated using loco-regional and general medical therapy, 9 developed pseudo aneurysm over time for which it was then necessary to resort to surgery. DISCUSSION AND CONCLUSION. Currently there is no universally accepted treatment protocol for the management of prosthesis infection. However, it is generally considered useful to isolate any pathological agent (using routine biopsies of arterial wall or thrombo-endoluminal fragments during the primary operation) before infection can develop so as to be able to commence specific antibiotic therapy. In this context the authors underline the more devastating action of some bacteria (pseudomonas, Staphylococcus aureus) in comparison to others (Staphylococcus epidermidis). Turning to therapeutic measures, when there are anatomical grounds and with the greatest possible respect for periarterial tissues, it is considered that trans-obturator bypass is preferable in the presence of manifest infection of the prosthesis, whereas medical therapy can be used (loco-regional + general) if infection is limited to the surface layers of the inguinal area. Possible complications over time may be corrected using surgery and in situ reconstruction if infection is no longer present.
腹股沟区假体感染的发生率在1%至3%之间，发病率和死亡率都很高。无论污染是内源性还是外源性的，都可能在手术期间或术后发生，这是由于继发细菌负荷所致，而继发细菌负荷通常与组织的创伤性手术技术有关，这种情况常见于急诊手术或再次手术中。材料与方法。在过去5年里，我们血管外科共进行了410例人工异体移植物植入手术，其中至少有一处吻合口位于腹股沟水平。用于制作假体的材料是涤纶和聚四氟乙烯。在腹股沟区观察到31例感染，其中11例涉及假体，20例明显局限于真皮的浅层和深层。总是进行细胞培养试验和药敏试验。根据个体情况采用手术或药物治疗（局部+全身）。结果。对于11例假体明显感染的患者，只有经闭孔旁路手术取得了良好的长期效果，而其他手术（股-股旁路、腋-腘旁路）效果不佳。在另外20例采用局部和全身药物治疗的患者中，有9例随着时间的推移出现了假性动脉瘤，随后有必要进行手术。讨论与结论。目前，对于假体感染的处理尚无普遍接受的治疗方案。然而，一般认为在感染发生之前分离出任何病原体（在初次手术期间对动脉壁或血栓内膜碎片进行常规活检）是有用的，以便能够开始进行特异性抗生素治疗。在这种情况下，作者强调了一些细菌（铜绿假单胞菌、金黄色葡萄球菌）比其他细菌（表皮葡萄球菌）具有更强的破坏作用。谈到治疗措施，当有解剖学依据且尽可能尊重动脉周围组织时，在假体明显感染的情况下，经闭孔旁路手术被认为是更可取的，而如果感染仅限于腹股沟区的表层，则可采用药物治疗（局部+全身）。如果感染不再存在，随着时间推移可能出现的并发症可通过手术和原位重建来纠正。
