在腹腔大动脉移植和内移植感染中,半保守治疗与激进手术相比

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Hamid Gavali¹, Kevin Mani¹, Mia Furebring²

¹Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

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概括

对于腹腔大动脉移植感染 (AGIs) 的激进手术 (RS) 显示了与半保守 (SC) 治疗相似的生存率,当调整为并发症时. 然而,SC治疗导致明显更高的复发感染率.

科学领域:

血管外科血管外科
传染性疾病传染性疾病
外科手术的结果

背景情况:

腹腔大动脉移植感染 (AGIs) 是罕见的,但是在大动脉手术后的严重并发症.
彻底手术 (RS) 是首选的治疗方法,涉及移植切除和重建.
半保守 (SC) 策略,保存移植,是不适合RS的患者的选择.

研究的目的:

为了比较激进手术 (RS) 和腹腔大动脉移植感染 (AGIs) 的半保守 (SC) 治疗之间的生存和感染结果.
分析针对AGI治疗的全国患者队列的结果.

主要方法:

在瑞典 (1995-2017年) 确定了一组全国性的手术治疗腹部AGI患者队列.
大动脉移植感染协作管理 (MAGIC) 标准定义了AGI.
用多变量回归和卡普兰-梅尔生存分析来比较SC和RS组之间的结果.

主要成果:

确定了169名患者:43人接受SC治疗,126人接受RS治疗.
该SC队列年龄较大,患有更多的心脏并发症.
虽然卡普兰-梅尔生存率显示出对SC的低生存率的非显著趋势 (30.2%与5年后的48.4%相比),调整后的考克斯回归没有发现显著的死亡率差异 (HR1.0). 在SC组中,复发性感染显著高 (45.4%对19.3%). 移植肠 (GEF) 对SC患者的生存率产生了负面影响.

结论:

在这个国家AGI队列中,在SC和RS之间5年死亡率没有显著差异,当调整为并发病时.
半保守治疗与明显更高的复发移植感染率有关.
移植肠的存在可能会使接受SC治疗AGI的患者的生存结果恶化.

关键词:

大动脉移植感染多中心多中心.在全国范围内全国范围.这是一项彻底的外科手术.半保守的半保守的

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