Fichelle J M, Tabet G, Cormier P, Farkas J C, Laurian C, Gigou F, Marzelle J, Acar J, Cormier J M
Department of Vascular Surgery, Saint Joseph Hospital, Paris, France.
J Vasc Surg. 1993 Apr;17(4):635-45. doi: 10.1067/mva.1993.38670.
Twenty-five infected infrarenal aortic aneurysms operated on between 1968 and 1989 were reviewed. They were classified into post-embolic (mycotic) aneurysms (group I), infective aortitis (group II), and infected atherosclerotic aneurysms (group III). Aortoduodenal fistulas were found in eight patients and aortocaval in two. Five patients were operated on in a state of shock, and 12 had preoperative positive blood cultures. Surgical procedures included in situ reconstruction of the aorta (n = 21) and extra-anatomic bypass associated with aneurysmal resection (n = 4). In 19 patients, prostheses were covered with omental flaps, and antibiotics were continued for more than 6 weeks in all patients. In patients who underwent in situ reconstruction, three deaths were related to the initial surgery. All surviving patients were regularly followed up, and none showed any sign of late septic recurrence. In patients who underwent extra-anatomic bypass, two died in the postoperative period, one underwent reoperation 2 years after the initial surgery, and the last patient is doing well. Positive postoperative blood cultures (n = 4) revealed persistent sepsis: two cholecystitis, one spondylitis, and one aortic infection. An exhaustive review of the literature was performed; clinical, bacteriologic, and operative features and results were analyzed; prognostic factors were evaluated; and a practical therapeutic approach was suggested. The importance of preoperative diagnosis, complete resection, debridement of infected tissues, omental flap coverage, and long-term antibiotic therapy with regular computerized tomographic scanning follow-up is stressed.
对1968年至1989年间接受手术治疗的25例感染性肾下腹主动脉瘤进行了回顾性研究。它们被分为栓塞后（霉菌性）动脉瘤（I组）、感染性主动脉炎（II组）和感染性动脉粥样硬化性动脉瘤（III组）。发现8例患者存在主动脉十二指肠瘘，2例存在主动脉腔静脉瘘。5例患者在休克状态下接受手术，12例术前血培养呈阳性。手术方式包括主动脉原位重建（n = 21）和与动脉瘤切除相关的解剖外旁路手术（n = 4）。19例患者的假体用网膜瓣覆盖，所有患者均持续使用抗生素超过6周。在接受原位重建的患者中，3例死亡与初次手术有关。所有存活患者均接受定期随访，无一例出现晚期脓毒症复发迹象。在接受解剖外旁路手术的患者中，2例术后死亡，1例在初次手术后2年接受再次手术，最后1例患者情况良好。术后血培养阳性（n = 4）显示存在持续性脓毒症：2例胆囊炎、1例脊柱炎和1例主动脉感染。对文献进行了详尽回顾；分析了临床、细菌学、手术特征及结果；评估了预后因素；并提出了切实可行的治疗方法。强调了术前诊断、彻底切除、感染组织清创术、网膜瓣覆盖以及长期抗生素治疗并定期进行计算机断层扫描随访的重要性。
