摘要
目的探讨注射毒品致股动脉感染性假性动脉瘤的血循环重建方法。方法 2003年11月-2009年5月,收治84例因注射毒品致股动脉感染性假性动脉瘤患者。其中男67例,女17例;年龄19～51岁,平均34.6岁。注射毒品时间1～11年,平均2.7年。13例股动脉缺损3～10 cm,其余患者股动脉破口范围1.0 cm×0.3 cm～3.0 cm×0.7 cm。5例行ePTFE人工血管旁路转流,29例行自体大隐静脉移植,24例行股动脉破口修补,26例行股动脉结扎。结果 2例患者术中下肢深静脉血栓脱落致肺栓塞死亡。8例术后出现切口感染,拆除部分或全部缝线,经换药后切口愈合,其余患者切口均Ⅰ期愈合。56例行血管重建或修补的患者,术后足背动脉搏动恢复或增强,无远端肢体骨筋膜室综合征发生;26例行股动脉结扎的患者,术后1周行CT下肢动脉血管重建或下肢动脉造影显示肢体远端均有丰富来自同侧髂内动脉、臀上动脉以及对侧髂内动脉的侧支循环。82例术后获12～36个月随访,平均17.3个月。3例出现间歇性跛行,经扩血管,活血化瘀等药物治疗后好转,肢体功能良好;其余行走正常。结论注射吸毒致股动脉感染性假性动脉瘤应尽早外科手术治疗,彻底清创引流、髂外动脉-股浅动脉旁路带支撑环人工血管或大隐静脉重建以及破口修补,是有效的治疗方法。在感染严重、局部条件无法重建血管的情况下,结扎股动脉也是一种可行选择。
Objective To summarize the revascularization method of infective femoral false aneurysm caused by drug injection. Methods Between November 2003 and May 2009, 84 patients with infective femoral false aneurysm caused by drug injection were treated, and the clinical data were analysed retrospectively. There were 67 males and 17 females with an average age of 34.6 years （range, 19-51 years）. The average duration of drug injection was 2.7 years （range, 1-11 years）. In 13 cases, the defect of femoral artery was 3-10 cm; defect ranged from 1.0 cm×0.3 cm to 3.0 cm × 0.7 cm in the others. The surgical treatment included bypass using synthetic grafts in 5 cases, great saphenous veins transplantation in 29 cases, repair of femoral artery in 24 cases, and ligation of femoral artery in 26 cases. Results Two cases died of intraoperative pulmonary embolism. Eight cases had postoperative wound infection, which was cured after changing dressings. Incisions healed by first intention in the other parents. A total of 82 cases were followed up 12-36 months （mean, 17.3 months）. In 56 patients undergoing artery reconstruction or repair, dorsal pedis artery pulse was significantly improved, and no distal osteofascial compartment syndrome occurred. In 26 patients undergoing femoral artery ligation, angiography at 1 week after operation showed abundant collateral circulation from ipsilateral internal iliac artery, superior gluteal artery or contralateral internal iliac artery. Three cases bad postoperative intermittent claudication which was improved after symptomatic treatment. Conclusion Infective femoral false aneurysm caused by drug injection should be treated surgerically as early as possible, and effective treatments include debridement, drainage, defect repair or bypass with synthetic graft or great saphenous vein from homonvmv external iliac artery to superficial femoral artery. Ligation of femoral artery is an option in patients with serious infection when revascularization is impossible.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第8期1001-1003,共3页
Chinese Journal of Reparative and Reconstructive Surgery
