利福平浸泡移植物治疗布鲁氏菌感染的主/髂动脉瘤的临床经验

doi:10.6040/j.issn.1671-7554.0.2025.0723

摘要/Abstract

摘要： 目的探讨利福平浸泡移植物治疗布鲁氏菌引起的主/髂动脉感染性动脉瘤的有效性和安全性。方法回顾性分析新疆维吾尔自治区人民医院2016年10月至2021年11月期间连续接受利福平浸泡移植物治疗的10例布鲁氏菌继发的感染性动脉瘤(Brucella-induced infectious aneurysms, B-IAA)患者的临床资料,其中男9例、女1例,均接受了急诊/紧急手术,其中7例患者采用利福平浸泡覆膜支架行腔内修复,3例患者采用利福平浸泡涤纶材料人工血管行开放原位重建。根据病例资料及随访情况,统计分析术后30 d存活情况、治疗相关并发症、再感染发生情况、移植物通情况、主动脉相关死亡情况。结果 10例患者均获得手术成功,术后30 d内无死亡病例。3例出现围手术期和术后并发症,其中1例患者术后出现凝血功能障碍和腹膜后出血,经输血等保守治疗后痊愈;1例髂动脉支架患者术后10个月发生再感染行开放手术,15个月后死于脑血管疾病;1例患者术后40 d死于脓毒症引起的多器官功能衰竭。随访1~103(41.8±27.6)个月,1例患者术后2年不明原因死亡,1例患者腹主动脉瘤腔内修复术后4年胸主动脉出现小动脉瘤(未干预),其他患者均无主动脉、移植物相关干预。结论利福平浸泡的移植物是治疗B-IAA有效手段,不论是腔内修复还是开放手术,都取得良好效果。

关键词: 感染性动脉瘤, 布鲁氏菌病, 利福平, 血管腔内修复, 原位重建

Abstract: Objective To explore the efficacy and safety of rifampicin-soaked grafts in the treatment of Brucella-induced aorto-iliac artery infectious aneurysms. Methods This study retrospectively analyzed the clinical data of 10 consecutive patients with Brucella-induced infectious aneurysms(B-IAA)who received rifampicin-soaked grafts at the Peoples Hospital of Xinjiang Uygur Autonomous Region from October 2016 to November 2021. All 10 patients(9 males and 1 female)underwent emergency/urgent surgery. Seven patients underwent endovascular repair with rifampicin-soaked covered stents, and 3 patients underwent open in situ reconstruction with rifampicin-soaked Dacron grafts. Based on the case data and follow-up information, the 30-day survival rate after surgery, treatment-related complications, re-infection rate, graft patency, and aortic-related mortality were statistically analyzed. Results All 10 patients achieved successful surgery. There were no deaths within 30 days after surgery. Three patients experienced perioperative and postoperative complications. One patient developed coagulation dysfunction and retroperitoneal hemorrhage after surgery and recovered after conservative treatment such as blood transfusion. One iliac artery stent patient developed re-infection 10 months after surgery and underwent open surgery, and died of cerebrovascular disease 15 months later. One patient died of multiple organ failure caused by sepsis 40 days after surgery. The average follow-up was 1-103(41.8±27.6)months. One patient died of unknown causes 2 years after surgery, and one patient developed a small thoracic aortic aneurysm 4 years after endovascular repair of the abdominal aortic aneurysm(no intervention). The remaining patients had no aortic or graft-related interventions. Conclusion Rifampicin-soaked grafts is an effective treatment for B-IAA, and both endovascular and open surgeries have achieved good results.

Key words: Infected arterial aneurysms, Brucellosis, Rifampicin, Endovascular repair, In situ reconstruction

中图分类号:

R654.3

杨建平,管圣,戈小虎. 利福平浸泡移植物治疗布鲁氏菌感染的主/髂动脉瘤的临床经验[J]. 山东大学学报 (医学版), 2025, 63(12): 17-25.

YANG Jianping, GUAN Sheng, GE Xiaohu. Clinical analysis of rifampicin-soaked grafts in the treatment of Brucella infection in aorto-iliac artery aneurysms[J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 17-25.

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