布氏杆菌感染性腹主动脉瘤腔内治疗1例——病例报道及文献复习
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Endovascular repair for Brucell-infected abdominal aortic aneurysm: one case report and literature review
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    摘要:

    感染性动脉瘤较为罕见,而布氏杆菌感染引起腹主动脉瘤极为罕见。感染性主动脉瘤经典的治疗术式是彻底清创,解剖外建立血管通路,结合围术期应用抗生素治疗。但近年来主动脉腔内修复术的应用逐渐有了较多的报道,且取得较好的疗效。我们报道了感染性腹主动脉瘤患者行腔内修复术1例并进行相关文献复习。作者回顾1例布氏杆菌引起的感染性腹主动脉瘤患者的临床资料。该患者为76岁男性,之前无相关感染病史。主要表现为发热、腹部搏动性包块和腰腹部疼痛。术前外周血培养提示布氏杆菌感染,给予多西环素治疗有效。CT血管造影提示腹主动脉远端假性动脉瘤。入院后行腔内修复术,术后继续应用敏感抗生素治疗,定期随访。回顾之前发表的其他病例数据,总结布氏杆菌感染性腹主动脉瘤腔内治疗的相关经验。经血管腔内放置覆膜支架修复联合抗生素治疗,手术成功;出院后随访4个月,随访4个月后,患者生命体征正常。因此,对于布氏杆菌引起的感染性动脉瘤,在术前充分抗感染、控制血压,术后长期应用抗生素的前提下,进行腔内修复治疗的思路是可行的。

    Abstract:

    Infected aortic aneurysm (IAA) are very rare, and those caused by Brucella are extremely rare. The conventional treatment for IAA is wide debridement of necrotic tissue, establishment of vascular bypass, and perioperative antibiotic treatment. But in recent years, much evidence showed that endovascular treatments were gradually applied as alternatives to open surgery, and the treatments have good outcomes. To summarize our treatment experience of endovascular repair for infected abdominal aorta aneurysm, we reported a case of a 76-year-old male patient and reviewed the articles concerning this disease. The patient had no primitive infectious source (area), and mainly presented fever, abdominal pulsatile mass and waist and abdomen pain. Preoperative peripheral blood culture suggested Brucella infection, and doxycycline treatment was effective. CT angiography displayed a pseudoaneurysm of the distal abdominal aorta. After admission, he underwent endovascular repair treatment followed by sensitive antibiotic therapy, and then was followed up regularly. We also reviewed other cases in the previously published data to summarize the experience on endovascular treatment for Brucella-related abdominal aortic aneurysm, that is, endovascular repair of coated stent graft combined with antibiotic therapy. The patient was followed up for 4 months, and he has normal vital signs at the end of follow-up. On the condition of strict preoperative blood pressure and infection control, and postoperative long-term antibiotic therapy, endovascular treatment is a feasible approach to treat Brucella-caused IAA.

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刘 端,刘 秀,刘 暴*,宋晓军,郑月宏.布氏杆菌感染性腹主动脉瘤腔内治疗1例——病例报道及文献复习[J].中华老年多器官疾病杂志,2016,15(03):225~230

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  • 收稿日期:2016-12-02
  • 最后修改日期:2016-12-28
  • 录用日期:2016-12-28
  • 在线发布日期: 2016-03-28
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