Sriussadaporn S
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Int Surg. 1996 Oct-Dec;81(4):395-9.
Fourteen patients with infected aortic aneurysms who were admitted to Chulalongkorn Hospital, Bangkok, Thailand from January 1990 to December 1995 were studied. Inclusion criteria were obvious infection found at operations and positive cultures of the aneurysmal sac or contents. Severity of infection found at operations was divided into no, mild, and severe periaortic infection. Eight patients who had no or mild periaortic infection underwent in situ grafting. All of them survived and were discharged home. Four of them are still well at present. None of them developed subsequent graft infection. Of the remaining 6 patients who had severe periaortic infection, one underwent drainage of the retroperitoneal abscess followed by excision of the infected aneurysm and axillobifemoral bypass 2 weeks later. This patient survived and was discharged home but died 4 months later from graft occlusion and sepsis. Of the remaining 5 patients, 3 had in situ grafting and 2 had axillobifemoral bypass. All of them died from sepsis and multiple organ failure in the early postoperative period. Positive culture for gram negative enteric bacteria were obtained in all patients. The study demonstrates that in situ grafting can be safety performed if there is no or only mild periaortic infection and adequate clearance of the infected aorta and periaortic tissue is obtained after an aggressive debridement. A long-term antibiotic administration is recommended.
对1990年1月至1995年12月期间入住泰国曼谷朱拉隆功医院的14例感染性主动脉瘤患者进行了研究。纳入标准为手术中发现明显感染且动脉瘤囊或内容物培养阳性。手术中发现的感染严重程度分为无、轻度和重度主动脉周围感染。8例无或轻度主动脉周围感染的患者接受了原位移植。他们全部存活并出院回家。其中4例目前仍然状况良好。他们均未发生随后的移植物感染。其余6例有严重主动脉周围感染的患者中，1例接受了腹膜后脓肿引流，2周后切除感染的动脉瘤并进行腋-双股旁路移植术。该患者存活并出院回家，但4个月后因移植物闭塞和败血症死亡。其余5例患者中，3例接受了原位移植，2例接受了腋-双股旁路移植术。他们均在术后早期死于败血症和多器官功能衰竭。所有患者的革兰氏阴性肠道细菌培养均为阳性。该研究表明，如果没有或仅有轻度主动脉周围感染，并且在积极清创后对感染的主动脉和主动脉周围组织进行了充分清除，则可以安全地进行原位移植。建议长期使用抗生素。
