中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

血管移植物相关感染应对策略

章希炜，蒋    军   

  1. 南京医科大学第一附属医院血管外科，江苏南京 210029
  • 出版日期:2016-02-01 发布日期:2016-01-29

  • Online:2016-02-01 Published:2016-01-29

摘要：

血管移植物感染（VGI）是血管外科比较少见但具有挑战性的一种并发症，其后果严重，病死率和截肢率均很高。目前，临床上缺少相关的指南指导VGI的诊断和治疗。VGI缺乏典型的临床表现，CT检查在VGI的诊断中具有一定的价值。针对围手术期VGI的易感因素，可以采取多种预防措施。须结合病人的全身情况、VGI发生部位、致病菌的种类和各血管中心的临床经验来制定措施为个体化治疗策略。具体的治疗措施为移除感染的血管移植物，充分清创引流，行或不行血管重建术。对于特定的病人，也可以保留移植物，行抗感染治疗联合局部处理。

关键词: 血管移植物感染, 人工血管感染

Abstract:

Management strategies of vascular graft related infection          ZHANG Xi-wei，JIANG Jun. Department of Vascular Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029, China
Corresponding author: ZHANG Xi-wei，E-mail: xiwei1092@163.com
Abstract    Vascular graft infection (VGI) is a rare and challenging complication of vascular surgery，which carries signi?cant associated morbidity and mortality. There are no clear guidelines for diagnosing and treatment. There are multiple non-specific symptoms and signs associated with VGI. CT-scan is considered to be a useful diagnostic tool. Treatment of perioperative VGI has not been well de?ned as it is fairly uncommon. Based on the multiple underlying mechanisms of VGI，many perioperative strategies may be used to reduce graft infection rate. Individualized management depends on the patient’s condition，site of graft implantation，type of infecting pathogens and surgeon’s experience. Graft removal and reconstruction may be mandatory when indicated. Conservative treatment with graft preservation is based on antibiotic therapy combined with percutaneous drainage under CT-scan guidance or local debridement in selected patients.

Key words: vascular graft infection, prosthesis infection