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題 名 | Repair of Arteriotomy after Removal of Infected Hemodialysis Access by Venous Graft=洗腎用人工血管感染摘除手術後動脈出血的外科處理:以靜脈作徹底修補 |
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作 者 | 武孟餘; 柯博仁; 謝宏昌; 朱肇基; 林萍章; 劉永恆; | 書刊名 | 長庚醫學 |
卷 期 | 26:12 2003.12[民92.12] |
頁 次 | 頁911-918 |
分類號 | 416.26 |
關鍵詞 | 動靜脈瘻管; 人工血管; 腎臟透析; 術後併發症; Arteriovenous shunt; Blood vessel prosthesis; Renal dialysis; Postoperative complications; |
語 文 | 英文(English) |
中文摘要 | 背景:洗腎用人工血管感染是洗腎通路術後的嚴重的併發症之一,通常須要以外科手術將人工血管摘除。而在人工至管摘除之後的動脈端修補處,有時會有手術後持續感染動脈破裂造成大出血。本研究回顧了本院對於此種動脈出血狀況以大隱靜脈作動脈修補的經驗及分析相關的危險因子。 方法:在2000年1月到2001年2月間,一共有31例的嚴重洗腎用人工血管感染接受人工血管的摘除手術,而動脈端是以直接縫合動脈切口或人工血管殘留端作為處理方式。(平均年齡63.6歲;16男15女)其中有7人發生術後動脈破裂出血而緊急手術。(5男2女)其中6人我們以靜脈繞道手術作為破裂動脈的徹底修補,1人則進行了肱動脈結紮手術。 結果:本報告描述了感染性洗腎用人工至管摘除後,動脈端若是僅作簡單縫合則可能有高達22.6%的術後出血可能。而術前血液細菌培養場性則為術後動脈出血的危險因子。所有的病人在以靜脈繞道手術作徹底修補後都能後康復。 結論:洗腎用人工血管感染,若比人術前的血液培養是陽性,則建議在人工血管摘除手術時徹底清創後以靜脈血管繞道術作動脈之徹底修補,而不是僅作動脈切口或人工至管殘留端之簡單縫合,以避免術後動脈持續感染出血以及充份保持遠端肢體的血流供應。 |
英文摘要 | Backgorund: Traditionally, extensive prosthetic arteriovenous (AV) graft infection is treated with graft removal and the arteriotomy or the graft stumps were simply sutured following the removal of the graft. However, postoperative bleeding may occur which requires emergent intervention. We report the results achieved at our clinic after arteriotomy repair with venous graft interposition in re-bleeding conditions. Methods: From January 2000 through February 2001, 31 patients with extensive graft infections underwent graft removal with direct closure of the arteriotomy or graft stumps at our clinic. Seven of these patients experienced re-bleeding from the repaired brachial artery. Six of them received repair of the brachial artery with venous graft interposition and one received brachial artery ligation. Results: Surgery of the infected dialysis graft removal ws associated with a high rebleeding rate (22.6%) in our group. In this study, we analyzed the preoperative data, including age, gender, incidence of diabetes mellitus, incidence of preripheral artery occlusive disease, and preoperative blood culture. Both univariate and multivariate analyses showed that the positive preoperative blood cultures were the only factors related to postoperative bleeding (Odds Ratio 2.8, p=0.009<0.05). All of the patients that received brachial artery repair with venous graft interposition recovered well. Conclusion: In the patients with positive blood cultures, we recommended brachial artery repair with enous graft interposition rather than simple closure of the arteriotomy or graft stump after removal of the infected graft. This may prevent re-bleeding due to inadequate debridement and eliminate the possibility of ispsilateral hand ischemia due to brachial artery stenosis following simple closure of the arteriotomy. |
本系統中英文摘要資訊取自各篇刊載內容。