胸主动脉腔内修复术后带蒂背阔肌肌瓣脓肿清创联合覆膜支架包裹治疗感染性胸主动脉瘤,Journal of Cardiothoracic Surgery

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胸主动脉腔内修复术后带蒂背阔肌肌瓣脓肿清创联合覆膜支架包裹治疗感染性胸主动脉瘤
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-02-02 , DOI: 10.1186/s13019-023-02155-y
Hirokazu Matsushima ₁ , Tohru Ishimine ₁ , Naoki Taniguchi ₁ , Toshiho Tengan ₁

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迄今为止，开胸手术（感染性病灶切除、人工移植物置换和带蒂组织瓣）仍然是感染性胸主动脉瘤的主要治疗方法。最近的报告强调了胸主动脉腔内修复术的良好预后结果。然而，感染性胸主动脉瘤的胸主动脉腔内修复术与残留感染组织引起的感染加重有关。我们讨论了感染性胸主动脉瘤血管内治疗后难治性感染的控制。一名 81 岁的男性，有胰岛素依赖型糖尿病和胰十二指肠切除术病史，因发烧到我们急诊科就诊。验血显示白细胞计数明显升高，对比增强计算机断层扫描提示胸降主动脉假性动脉瘤。我们诊断患者患有感染性胸降主动脉瘤，并进行了紧急胸主动脉腔内修复术；他开始接受静脉内抗生素治疗。术后，血液检查显示白细胞计数减少，患者仍未发热。然而，计算机断层扫描显示脓肿腔暂时扩大；因此，行脓肿清创术和带蒂背阔肌肌瓣包裹覆膜支架，成功控制了感染。脓肿清创后六周，患者转为口服抗生素治疗。手术后 8 个月没有感染复发的证据。联合脓肿清创术和带蒂组织瓣方法对于手术耐受性差的患者是有用的，这些患者在感染性胸主动脉瘤的胸主动脉腔内修复术后感染控制困难。当使用大网膜进行带蒂组织瓣困难时，带蒂背阔肌肌瓣很有用。

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Treatment of infected thoracic aortic aneurysm with combined abscess debridement and stent-graft wrapping using pedicled latissimus dorsi muscle flaps after thoracic endovascular aortic repair

Open thoracic surgery (with infected lesion removal, prosthetic graft replacement, and pedicled tissue flap) has remained the main treatment for infected thoracic aortic aneurysms to date. Recent reports have highlighted good prognostic outcomes with thoracic endovascular aortic repair. However, thoracic endovascular aortic repair for infected thoracic aortic aneurysms is associated with an exacerbation of infection due to residual infected tissues. We discuss the control of refractory infections following endovascular treatment of infected thoracic aortic aneurysms. An 81-year-old man, with a history of insulin-dependent diabetes mellitus and pancreaticoduodenectomy, presented to our emergency department with a fever. Blood tests revealed a markedly elevated leukocyte count, and contrast-enhanced computed tomography suggested a descending thoracic aortic pseudoaneurysm. We diagnosed the patient with an infected descending thoracic aortic aneurysm, and performed urgent thoracic endovascular aortic repair; he was started on an intravenous antibiotic treatment. Postoperatively, blood tests revealed a decreased leukocyte count and the patient remained afebrile. However, computed tomography revealed temporal enlargement of the abscess cavity; therefore, an abscess debridement and stent graft wrapping with pedicled latissimus dorsi muscle flaps were performed, which successfully controlled the infection. Six weeks after abscess debridement, the patient was switched to an oral antibiotic therapy. There was no evidence of recurrence of infection 8 months after the surgery. A combined abscess debridement and pedicled tissue flap approach is useful for patients with poor surgical tolerance in whom infection control is difficult after thoracic endovascular aortic repair for infected thoracic aortic aneurysms. Pedicled latissimus dorsi muscle flaps are useful when using the omentum for pedicled tissue flap is difficult.

更新日期：2023-02-03

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